Implementing a Direct Peritoneal Resuscitation Protocol to Improve Outcomes in Abdominal Surgery

Abstract

Problem and Purpose: Direct Peritoneal Resuscitation (DPR) is an emerging therapy that mitigates complications from traumatic abdominal injuries requiring surgical intervention. A level-1 trauma center located within an urban academic medical center utilizes DPR to accelerate patient recovery after a damage control laparotomy. The hospital does not have a clinical practice guideline (CPG) or EPIC order set (EOS) for DPR, leading to variable practices and inconsistent care delivery. With various DPR recommendations in the literature, the need for a standardized DPR practice was imperative to ensure patient safety and enhance care delivery. The purpose of this quality improvement initiative was to develop an evidence-based CPG and EOS for DPR. A standard of care was developed by the CPG and EOS, enabling the benefits of increased abdominal surgical closure rates, reduced number of surgeries, complications, and ICU and hospital length of stay (LOS). Methods: An evidence-based CPG was developed from published data that supported the targeted patient outcome benefits. An EOS was developed from the CPG that created a streamline method of ordering DPR care, including fluid infusion rates, nursing care orders, laboratory monitoring, and provider notification parameters. Implementation occurred over a 14-week period in the Fall of 2022 and included surveys of staff education and training, EOS utilization, and patient outcome data. Results: There was an 83.8% increase in the number of trained staff and 86% improvement in staff education and utilization of the DPR EOS. Hospital and ICU LOS were reduced in the postimplementation group compared to the pre-implementation group (25.5 vs. 39.28 days; 16.5 vs. 29.42 days, respectively). Limitations of the study included poor generalizability due to the small post-intervention group sample size (n=2). All other metrics were comparable between groups. Conclusions: There was increased proficiency and utilization rates for the CPG and EOS. Postimplementation patients had shorter hospital and ICU lengths of stay.