Survey on Hospital Factors Affecting Failure to Rescue in Pancreatic Surgery - PancreasGroup.org 2 Introduction A global survey is conducted to evaluate hospital-related factors impacting Failure to Rescue (FTR) post-pancreatic surgery. FTR relates to the rate of mortality after a major complication, and is a key metric in surgical outcomes, patient safety, and hospital quality. Previous studies have focused on patient- or hospital volume-related factors affecting FTR, with limited exploration of potentially modifiable aspects on an institutional level. Understanding hospital-related factors could however greatly reduce FTR rates. Experts in pancreatic surgery are asked to rate specific factors based on their institutional experience, providing vital insights into potentially modifiable risks associated with FTR, thereby contributing to the enhancement of global patient care and safety standards. The survey opened on 15 December 2023 and the deadline for submission has been extended to February 29, 2024. It takes approximately 10 minutes to complete, requiring all questions to be addressed for submission. Anonymity of the survey responses for both participants and their institutions in the data reporting are ensured. PubMed citable co-authorship will be offered to all participants. Click here to download the paper version of the survey. Personal Information Please provide your personal and institution information exactly as you would like them to appear in future publications. 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Specialized Care and Expertise Pancreatic surgery requires specialized surgical skills and optimal postoperative care, including support from interventional radiologists and endoscopists, to optimally deal with potential post-operative complications. Lack of such specialized expertise might influence the management of postoperative complications after pancreatic surgery, and therefore potentially affect Failure to Rescue (FTR) rates. 1a. How important do you rate having specialized surgical skills and knowledge in pancreatic surgery (i.e. at least 2 surgeons with dedicated training in pancreatic surgery) in preventing Failure to Rescue (FTR) at your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 1a. Availability at my institution Yes No 1b. How important would you rate the presence of specialized pancreatic or hepato-pancreato-biliary (HPB) surgical teams or units (including dedicated HPB nurses) within an institution, in influencing FTR? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 1b. Availability at my institution Yes No 1c. How important would you rate the availability of radiologists and endoscopists specialized in hepato-pancreato-biliary interventions within an institution, in influencing FTR? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 1c. Availability at my institution Yes No 1d. How significant do you rate the influence of performing pancreatic operations in academic hospitals as opposed to non-teaching institutions? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 1d. My hospital is Academic Non-Academic An academic hospital, often referred to as a teaching hospital, is a healthcare facility that is affiliated with a university or a medical school. 2. Volume-Outcome Relationship Hospitals that perform a higher volume of complex abdominal operations might have better outcomes than lower-volume hospitals when performing high risk complex pancreatic resections, as the medical teams are potentially more experienced in managing such cases and potential complications. 2a. In your opinion, how significant is the hospital volume-outcome relationship, i.e., performing a higher number of pancreatic resections over a certain time, in preventing FTR in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 2a. Numbers of pancreatic resections performed annually (e.g. in 2022) at my institution? Please provide an estimate if you are not aware of the exact number. 3. Advanced Monitoring and Response Pancreatic surgery patients require close postoperative monitoring to quickly address severe complications such as pancreatic fistula, sepsis and hemorrhage. The lack of advanced monitoring techniques and immediate intervention strategies might affect the detection of complications and the management thereof. 3a. How do you rate the importance of advanced monitoring techniques of patients in an intensive care or advanced care unit immediately post-pancreatic surgery in influencing FTR? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 3a. Availability at my institution Yes No 3b. How do you rate the importance of adhering to standardized monitoring protocols in the early postoperative period, in influencing FTR outcomes? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 3b. Availability at my institution Yes No 4. Availability of Specialized Units and Infrastructure The complexity of pancreatic surgery necessitates continued specialized postoperative care, including intensive care units equipped to handle complications such as hemorrhage, infections, and organ failure, as well as interventional radiology and endoscopy units. The continued availability of such advanced units after patients have been stepped down to ward-level might influence outcomes. 4a. How significant is the continued availability and capacity of specialized surgical intensive care units for patients experiencing severe complications after pancreatic surgery (e.g. re-admission to the Intensive Care Unit following a complication)? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 4a. Availability at my institution Yes No 4b. How important do you rate the availability of specialized units such as interventional radiology or advanced endoscopy (e.g. ERCP) at the hospital site where the pancreatic surgery was performed, in preventing FTR? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 4b. Availability at my institution Yes No 4c. How important do you rate a fast and continuous availability (24 hours a day, 7 days a week) of specialized units such as interventional radiology or advanced endoscopy (e.g. ERCP)? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 4c. Availability at my institution Yes No 4d. How crucial do you rate the availability of hospital resources to address poorly maintained equipment or outdated facilities, potentially compromising highest standards patient care, with regards to FTR? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 4d. Availability at my institution Yes No 5. Prevention of Delayed Response Failure to recognize early signs of complications can delay necessary interventions. Inadequate rapid response systems and a lack of efficient response to emergencies may result in delayed diagnosis and treatment of complications. 5a. How important do you rate the efficiency of rapid response or code teams in influencing FTR outcomes after pancreatic surgery? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 5a. Availability at my institution Yes No 5b. How critical do you rate bureaucratic delays in obtaining necessary approvals or referrals within the hospital system for postoperative interventions such as interventional radiology, endoscopy or surgical procedures in determining FTR rates? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 5b. Frequently an issue at my institution Yes No 6. Clinical Guidelines and Protocols The absence of clear and up-to-date clinical guidelines and standardized protocols, including enhanced recovery after surgery (ERAS) protocols, might influence the management of complications specific to pancreatic surgery and patient discharge from intensive care or hospital units. 6a. How important do you rate the adherence to clinical guidelines and standard operating procedures (ERAS or other), and the documentation of deviations from the protocol, for managing complications specific to pancreatic surgery and preventing FTR in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 6a. Availability at my institution Yes No 6b. How crucial do you rate the presence and adherence to appropriate discharge policies such as fit-to-discharge checklists, e.g. to prevent premature discharge of patients due to reduced bed availability, in affecting the potential underdiagnosis of complications and FTR rates? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 6b. Availability at my institution Yes No 7. Multidisciplinarity and Hospital Culture A multidisciplinary approach involving surgeons, gastroenterologists, radiologists, interventional radiologists, pathologists, and other specialists is crucial for managing complications after pancreatic surgery. Hospitals lacking a coordinated multidisciplinary approach and inconsistent adherence to best practices, may face difficulties in managing complications effectively. 7a. How important do you rate the availability and coordination of a multidisciplinary team setting and dedicated meetings involving various specialists for managing complications after pancreatic surgery in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 7a. Availability at my institution Yes No 7b. How important is the institution's openness to adopting newer, evidence-based practices into the routine management of patients undergoing pancreatic surgery, in influencing FTR? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 7b. Availability at my institution Yes No 8. Postoperative Nutritional Support Proper nutritional support from specialized dieticians is crucial after pancreatic surgery, and failure to provide adequate nutrition may increase the risk of complications impacting a patient’s recovery. 8a. How critical do you rate the administration of proper nutritional support and counselling after pancreatic surgery in preventing FTR in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 8a. Availability at my institution Yes No 9. Staffing and Training Inadequate number of nursing staff or medical professionals to monitor postoperative patients effectively, and / or a lack of sufficient training and experience among the staff to recognize and manage complications promptly may affect outcomes. 9a. How crucial do you rate the influence of nurse-to-patient ratios in specialized units to prevent FTR after pancreatic surgery in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 9a. Availability at my institution Yes No 9b. How significant would you rate a specialized training of staff and nurses in the management of post-pancreatectomy complications in influencing FTR outcomes? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 9b. Availability at my institution Yes No 10. Communication and Coordination Inadequate communication during shift changes can lead to the omission of critical information about the patient’s condition. Failure in the coordination and communication among different members of the healthcare team may delay intervention. 10a. How significant do you judge effective communication and coordination among different healthcare teams in preventing FTR after pancreatic surgery in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 10a. Availability at my institution Yes No 10b. How critical do you rate efficient handovers between shifts with regards to preventing FTR after pancreatic surgery in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 10b. Availability at my institution Yes No Additional Insights Please provide any additional insights, considerations, or factors that you believe are significant in preventing FTR after pancreatic surgery in your institution. Additional insights
