Implementing a Frailty-Specific Postoperative Order Set to Improve Postoperative Outcomes in Frail Adults After Elective Thoracic Surgery.
Amani Allen, Mary Ann Francisco, Jessica Jatis and 9 others
PMID 38936412WHAT IT FOUND
A frailty postoperative order set increased frailty-related order use and nurse awareness, but hospital length of stay, complications, and 30-day readmissions did not change for frail and prefrail patients.
Key findings
01Surgical teams ordered the frailty postoperative order set for 68.6% of prefrail and frail patients during floor audits, compared with 0% before implementation.
02Nurse self-reported familiarity with frailty increased from 4.51 to 7.22 on a 10-point scale.
03Hospital length of stay, postoperative complications, and 30-day readmissions did not differ significantly for frail and prefrail patients between implementation periods.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single hospital and a before/after design, so other changes in care could explain differences. Patients were not randomised, and more open surgeries occurred before implementation, while the paper notes a shift toward minimally invasive surgery during the study. Nurse survey response fell from 35 of 45 to 20 of 50, so staff views may not represent all nurses. Floor audits relied on nurse self-report and could be affected by response, recall, or observer bias. Small patient sample and low complication rate made it hard to detect outcome differences. Staff turnover, COVID-19 restrictions, other initiatives, and surgical team rotations varied during implementation.
The easy way to misread this
Do not read the discharge difference as proof the order set improved patient outcomes. The order set bundled nursing activity, nutrition, sleep, delirium precautions, and consults to physical therapy, nutrition, social work, and geriatrics, and the postimplementation group also had fewer open surgeries and other hospital changes.