Marion van der Kolk Development, implementation and evaluation of high-risk surgery related clinical pathways in the intensive care: effects of a process intervention
Clinical pathways, or care pathways (CPs), are developed to provide optimal care for a specific patient group and overcome unwanted differences of given care between individual patients and individual care-providers.read more
Marion van der Kolk Development, implementation and evaluation of high-risk surgery related clinical pathways in the intensive care: effects of a process interventionClinical pathways, or care pathways (CPs), are developed to provide optimal care for a specific patient group and overcome unwanted differences of given care between individual patients and individual care-providers.
In the ICU, a CP could be a uniform protocol together with an hour-to-hour schedule of interventions or actions on deviations for a specific group of patients. This schedule should focus on recognition of deviations from the pathway by nurses and should enable them to start treatment within the boundaries of prescribed variances. We demonstrated that it is feasible to implement a predominantly nurse-driven hour-to-hour CP in the ICU for cardiac surgery patients. In addition, the use of the CP for all cardiac surgery patients resulted in more timely and better organized postoperative ICU treatment. Over time
more complex patients were treated according to the CP, clinical outcome improved. Needless to mention that other factors may also have contributed to better outcomes over these years. This high-volume high-risk surgery pathway was the blue print for the development and implementation of CPs in low volume, high-risk surgical procedures such as pancreas surgery and esophageal surgery. In these studies we did also analyze the effects relating to the outcome for the specific patient groups compared to a historical control group. We concluded that a successfully implemented CP will improve the quality of care, including a reduction of complications and can lead us to patient-centered care in the pathways with less registration of the near future if preset target, steeringinformation and a Prepare-act-reflect cycle are part of the dynamic pathway.
Date, time and location PhD defense
- Date: 15 November 2018
- Time: 16.30 hrs
- Location: Radboud Universiteit, Academiezaal Aula, Comeniuslaan 2
Marion van der Kolk(1963) graduated with first-class honors from medical School, University Groningen. She carried out the above doctoral research at the Department of intensive Care and Surgery of the Radboud University Nijmegen Medical Center, within the Radboud Institute of Health Sciences (RIHS). She works as a gastro-intestinal and pancreas surgeon at the department of surgery and until 2012 she worked parttime as an intensivist at the ICU of the Radbouddumc. Her focus is on quality and safety in peri-operative care. She was appointed in 2018 as clinical leader and chair of the projectteam to re-develop care pathways in the Radboudumc by the board of the Radboudumc.
- Promotors: Prof. P. Pickkers and prof. C.J.H.M. van Laarhoven
- Co-promotor: M. van den Boogaard PhD