Evaluating the implementation process of a multicomponent perioperative intervention for prevention of postoperative functional decline in geriatric patients: a qualitative study.

Abstract

Geriatric patients are at increased risk of developing postoperative neurocognitive disorders, including delirium. Existing evidence-based perioperative interventions need to be implemented into routine care to improve postoperative outcomes. In this qualitative interview study, we wanted to collect stakeholder experiences to understand the implementation process of a multi-component intervention to prospectively facilitate future implementation. Descriptive qualitative evaluation research. Single-centre at a German major urban academic hospital. 22 interviews were conducted with n = 7 geriatric patients after surgery who had received a comprehensive geriatric assessment and an individualised perioperative multi-component intervention, and n = 15 healthcare professionals, including nurses, physicians and medical assistants working in the perioperative care. Semi-structured interviews were conducted, addressing the implementation procedure of the multicomponent intervention and the experience with it within the routine setting. The implementation outcomes were adoption, acceptance, appropriateness, feasibility and sustainability. Transcribed audio recordings were analysed with directed content analysis. Most intervention components could be adopted during the pilot trial. Implementation barriers were identified. Limited resources and logistic constraints threatened feasibility and sustainability. Acceptance of patients and healthcare providers regarding an intervention depended on its perceived appropriateness, which varied per intervention component, workspace and duration of the implementation. We were able to replicate and extend previous findings on the implementation of improved perioperative care. To facilitate the implementation success and motivation to implement evidence-based measures, resource allocation needs to be adjusted and standard operational procedures, as well as the cross-sectional collaboration, must be simplified. NCT03325413.