Clinical, nursing and management outcomes in patients undergoing major surgery: role of care intensity, detection of clinical and instrumental parameters, genetic structure and standardization of care protocols

Project objectives

GENERAL OBJECTIVE

The general objective of this research is to measure the effects of the introduction of standardized protocols for global assessment and assistance in patients undergoing major abdominal surgery.

SPECIFIC OBJECTIVES

• Mapping of care processes followed in common clinical practice for patients undergoing major abdominal surgery - Estimation of human and material resources used in different lines of care process
• Evaluation of the feasibility and appreciation of the use of palmtop computers for data collection in clinical practice according to schemes with different flexibility
• Definition of shared protocols for clinical and nursing care for patients undergoing major surgery - Stimulation of collaboration between the various members of the hospital care teams for sharing organizational processes
• Construction of an index for predicting the risk of hospital infection based on laboratory data, genetic makeup of the patient and patient characteristics
• Validation of the index for the prediction of hospital infection risk
• Evaluation of the impact of different care intensity (in its frequency and "quantity" components) on clinical, nursing and managerial outcomes
• Evaluation of the sustainability in terms of workload on the staff of the application of increased intensity assistance protocols
• Evaluation of the economic sustainability of the application of increased intensity assistance protocols
• Evaluation of the applicability of a protocol for hand disinfection of nursing staff before and after assistance to each patient
• Evaluation of the effectiveness in reducing the incidence of hospital infections of a protocol for disinfecting the hands of nursing staff before and after assisting each patient

INDICATORS USED

• Mortality rate 30 and 90 days after surgery
• Incidence of reoperation at 7, 30 and 90 days
• Incidence of re-hospitalization related to the operation at 30 and 90 days
• Incidence of nosocomial infection defined according to CDC criteria
• Percentage of cases of infection correctly identified based on cutoffs defined for the proposed predictive index
• Incidence of surgical complications (dehiscence of anastomosis, mechanical occlusion, etc.)
• Incidence of ICU transfers during hospitalization
• Score in the various dimensions of health-related quality of life identified by the SF-36 questionnaire at hospitalization, every 7 days during hospitalization, at discharge and at 30 and 90 days after surgery
• Stress index of medical and nursing staff based on responses to questionnaires for measuring burnout and workplace satisfaction
• Direct costs of intra-hospital care for each patient

Start and end date

Project Manager

Prof. Giordano Dicuonzo - Associate Professor

Coordinating institution of the project

Other Institutions involved

• Surgical Clinic – University Biomedical Campus (Prof. Roberto Coppola)
• Microbiology Laboratory – Biomedical University campus of Rome (Prof. Giordano Dicuonzo)
• Department of Management Engineering – Polytechnic University of Milan (Prof. Cristina Masella)
• Institute of Hygiene – Catholic University of the Sacred Heart – (Prof. Gualtiero. Ricciardi)

Funding source(s).

Economic value of the project

168.767 euros of which 118.000 euros co-financed by MIUR