P044 - ERA OF ENHANCED RECOVERY AFTER SURGERY: LESSONS LEARNED FROM A QUALITY IMPROVEMENT INITIATIVE ASSESSMENT OF THE IWK HEALTH CENTRE ATRIAL SEPTAL DEFECT CARE MAP

Background: Clinical pathways, such as care maps, standardize patient care to enhance efficiency and outcomes. The Atrial Septal Defect (ASD) Care Map was implemented at the Pediatric Health Centre in 2017 to optimize post-operative care and reduce hospital stays. However, a low adherence rate (31% completion) indicated inconsistent use, prompting a quality improvement initiative to identify barriers, update the care map to reflect best practices, and relaunch it with enhanced education and stakeholder engagement.

METHODS AND RESULTS:

Methods: A mixed-methods approach was used, including interviews with nine interdisciplinary healthcare providers to identify challenges. The Evidence-based Practice for Improving Quality (EPIQ) framework guided the process, emphasizing education, stakeholder feedback, and continuous quality improvement strategies. The care map was revised based on best practices and stakeholder input, with structured education sessions, unit champion support, and regular progress reporting to reinforce adherence.

Results: Pre-implementation barriers included lack of awareness (reported by 100% of interviewees), inconsistent placement in charts, staff turnover, and perceived redundancy due to double charting. To address these issues, several interventions were introduced, including monthly education sessions, structured progress reporting, stakeholder feedback mechanisms, and unit champions to promote engagement and monitor adherence. The updated care map – the Fast Track Cardiac Surgery Care Map (FTCSCM) – clarified action steps, incorporated new clinical criteria, and emphasized streamlined documentation. Early feedback suggests increased completion rates - from 29% to 63% - and improved staff engagement, although ongoing data collection is needed to quantify the impact on length of stay and patient outcomes.

Conclusion: Relaunching the FTCSCM with best-practice updates and a structured education strategy has enhanced awareness, adherence, and stakeholder collaboration. Ongoing assessment will determine its long-term impact on standardizing care and reducing length of stay.