O Smith1, T MacLeod2, P Lim2, P Chitsabesan1, S Chintapatla3. 1. York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK. 2. Department of Plastic Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK. 3. York Abdominal Wall Unit, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK. srinivas.chintapatla@york.nhs.uk.
Abstract
PURPOSE: Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors' knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. METHODS: A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. RESULTS: We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. CONCLUSION: A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.
PURPOSE: Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors' knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. METHODS: A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. RESULTS: We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. CONCLUSION: A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.
Authors: Mike K Liang; Julie L Holihan; Kamal Itani; Zeinab M Alawadi; Juan R Flores Gonzalez; Erik P Askenasy; Conrad Ballecer; Hui Sen Chong; Matthew I Goldblatt; Jacob A Greenberg; John A Harvin; Jerrod N Keith; Robert G Martindale; Sean Orenstein; Bryan Richmond; John Scott Roth; Paul Szotek; Shirin Towfigh; Shawn Tsuda; Khashayar Vaziri; David H Berger Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: Karl Breuing; Charles E Butler; Stephen Ferzoco; Michael Franz; Charles S Hultman; Joshua F Kilbridge; Michael Rosen; Ronald P Silverman; Daniel Vargo Journal: Surgery Date: 2010-03-20 Impact factor: 3.982
Authors: David C Bosanquet; James Ansell; Tarig Abdelrahman; Julie Cornish; Rhiannon Harries; Amy Stimpson; Llion Davies; James C D Glasbey; Kathryn A Frewer; Natasha C Frewer; Daphne Russell; Ian Russell; Jared Torkington Journal: PLoS One Date: 2015-09-21 Impact factor: 3.240