Yoeri Bemelmans

General discussion and valorization 167 11 consult and debate the content of these protocols and processes with other healthcare professionals (e.g. physicians, nurses, planners, anaesthesiologists, hospital pharmacist, and other medical specialists). Furthermore, a point of contact is necessary as most of the process optimisations are accompanied by contrariety. In case of a setback, or adverse result of an optimisation, a project leader should be contacted to solve the arose problem. The ‘plan-do-check-act’ (PDCA) circle provides a tool for the basic principles of the optimisation. This optimisation process starts by outlining and analysing the current situation regarding clinical results (e.g. LOS, patient satisfaction, complication and readmission rate). Main reasons for the current (prolonged) LOS should be outlined. For example, statistics on pain scores, number of patients with PONV, early mobilisation success percentages, orthostatic intolerance, wound complications, urinary status etc. must be mapped. An analysis on the logistical process, the pathway from first contact preoperatively to last outpatient visit postoperatively, should be made, in order to streamline patients’ journey in-hospital. A profound analysis on patients’ needs and wishes regarding the perioperative process should be done in order to create ‘mind-set’ towards patient involvement in the perioperative treatment rather than a professional imposed process. In order to draw the ‘plan’ of optimisation, with its goal to improve the in-hospital process for patients and compromising the risk of peri- and direct postoperative complications. With an adequate ‘plan’, the elaboration of the current evidence-based protocols should be made and implemented to the pathway itself. Comparing the current protocolswith the state-of-the- art in the latest literature. This process is time consuming, inwhichaPAplays an important role as the connector in a guiding role between the patient and the multidisciplinary health-care professional team, reporting to the orthopaedic surgeon. Contrary evidence statements exist, for example as outlined in chapter 3 several types of administrations, time regimens and dosages can be used for TXA implementation [25-28]. The drafted protocols should be discussed, chosen and approved by all professionals within the team in order to create a supportive base. Without compliance, these optimised protocols are destined to fail, as the effectiveness depends on the practical usage. When the newly designed protocols are finished and ready to be implemented, the step ‘do’ takes effect. To create awareness of these novel protocols, communication towards all involved health-care professionals is paramount. Possible options to accomplish this are; (oral) presentations on the workplace with Q and A opportunities, (digital) update of the protocol database, issue a newsletter and/or subject-oriented training courses for several stakeholders (e.g. physiotherapists, nurses, planners), distribute new evidence- base insights and most important, provide evidence on the data extracted from their own patients population (ideally as published results).