pre-ERIS trial
A systematic analysis of factors hindering and supporting implementation of the ‘rElaparotomy on demand’ stRategy In patients with secondary peritonitiS
Eris, daughter of Zeus and Hera, goddess of strife, infamous for the initiation of the Trojan War.
Rationale
Secondary peritonitis is caused by a breach in the continuity of the gastrointestinal tract associated with a high mortality (30%). It is a condition that many healthcare professionals in all types of hospitals will encounter on a regular basis, since there are several thousands of cases in the Netherlands every year. The treatment is a highly multidisciplinary act where surgery forms the cornerstone. The RELAP trial showed that relaparotomy on demand (ROD) should be favoured above planned relaparotomy (PR) after the initial laparotomy. There were substantial significant differences in favour of the on-demand strategy with respect to the total number of relaparotomies, ICU and hospital stay. This resulted in significant reduction in costs of €17,664 per patient for the ROD strategy compared to PR. Although surveys show an increase in the use of ROD, the PR strategy is still adhered, leading to non-optimal care and unnecessary high costs.
A systematic analysis of factors hindering and supporting implementation of ROD is essential prior to the development of tailored implementation strategies. In 2010 the problem analysis will be conducted and will consists of six phases in which the Delphi-technique is incorporated. An expert panel formulates, classifies and ranks hindering and supporting factors. Next, a focus group formulates possible interventions geared at the top ranked factors. The factors proposed by the study group based on the expertise in the field will at least be considered in the ranking, just as the accompanying interventions. In the third phase a questionnaire is developed, containing the ranked hindering and promoting factors and the accompanying interventions. In phase four a systematic survey will be conducted in 20 hospitals (400 respondents) of varying size and expertise by filling in the developed questionnaire on location. The questionnaires will be analyzed to quantify and definitely rank the formulated factors and the accompanying interventions that can be incorporated in implementation strategies. In the final phase tailored implementation strategies will be developed based on these results. After evaluation of these intervention strategies in a future implementation study , 'Evaluation of implementation strategies for Relaparotomy on demand In secondary peritonitiS', the recommended intervention strategy could be transformed into a guideline on how to conduct the ROD strategy and optimize the implementation of ROD.
Funding for the pre-ERIS study is granted by:
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