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Objective: This multicenter study aimed to assess (1) the effect of an improvement collaborative on enhanced recovery after surgery (ERAS) protocol adherence after elective colectomy and (2) the association between adherence and patient outcomes. Background: ERAS pathways provide a framework to standardize care processes and improve postoperative outcomes in patients after colon surgery. Despite growing evidence of its effectiveness, adherence to these guidelines remains a challenge. Methods: This prospective, multicenter collaborative was initiated throughout 11 hospitals in Flanders, Belgium. A structured audit tool was used to study patient outcomes and adherence to 12 ERAS components, defined by the collaborative. Three retrospective audits (based on patient record analysis) were conducted in 2017, 2019, and 2021, respectively. Results: Overall, 740 patients were included (45.4% female; mean±SD age, 71±12 years). The overall adherence increased from 42.8% in 2017 to 58.4% in 2019 and 69.2% in 2021. Compared with low adherence, length of stay was increasingly reduced by 1.3 days for medium [95% confidence interval (95% CI): −2.5; 0.0], 3.6 days for high (95% CI: −4.9; −2.2), and up to 4.4 days for very high adherence (95% CI: −6.1; −2.7). Corresponding odds ratios for postoperative complications were 0.62 (95% CI: 0.33; 1.17), 0.19 (95% CI: 0.09; 0.43), and 0.14 (95% CI: 0.05; 0.39), respectively. No increase in 30-day readmissions was observed. Conclusions: A peer-constructed improvement collaborative effectively increases adherence to an ERAS protocol in individual hospitals. Across time, length of stay and postoperative complications decreased significantly, and a dose-response relationship was observed. [ABSTRACT FROM AUTHOR]

A patient safety incident (PSI) is considered to have an impact on nursing students. Healthcare professionals often feel personally responsible for the unexpected patient outcome and feel as though they have failed their patient. In this way they may become second victims of the incident. Little is known about possible initiatives from hospitals or teaching institutions regarding the support of their students involved in a PSI. The study aims to examine the prevalence, symptoms and support in the aftermath of a PSI in baccalaureate nursing students. A cross-sectional study in four teaching institutions for baccalaureate education across eleven campuses in Belgium. Students completed an online survey between February 2018 and March 2018. About one in three (38.4%) students were involved in a PSI during their clinical experience. Of these, 84.7% experienced second victim symptoms. Most common symptoms were hypervigilance (65.7%), stress (42.5%) and doubting knowledge and skills (40.6%). Besides negative effects, the PSI also led to a more positive attitude. Students expect most support and room for open discussion from staff nurses (80.8%). Nursing students may already become second victims during their education. PSIs have a major impact on their performance and personal life. Students have the right for a decent treatment, respect, understanding and compassion, support, transparency and the opportunity to contribute to improving procedures. Teaching institutions should therefore bear the responsibility to prepare students of the probability of the occurrence of PSIs during their clinical experience. f• Almost 85% of the students experienced second victim symptoms after the occurrence of a PSI. • Overall, 2.4% of baccalaureate nursing students considered quitting their training as result of a PSI. • About half the students (55.2%) who did not talk to the patient after a PSI think this was the right decision. • The students expect the most support from the staff nurses (80.8%). • It seems advisable to take steps to raise awareness of the occurrence of PSIs during the clinical experiences of students as well as to reinforce a safety culture. [ABSTRACT FROM AUTHOR]