Breaktrough Improvement collaborative for the care of colorectal cancer patients (BIC4CRC)

Colorectal cancer or colon cancer is the most common cancer in Europe. About one in 20 men and about one in 35 women get this condition during his/her life. In Flanders, there was an increase in the detection of colarectal cancer in 2014 by 21% in comparison with 2013 due to the Flemish population survey. As a result, colorectal cancer is detected at an earlier stage in 55- to 74-year-olds, which results in a better prognosis for the patient. Colorectal surgery is one of the most important treatments at this stage, but it is also extensive, complex and has a high degree of complication. Therefore, in recent years, perioperative care for these patients has been standardized, including the so-called Enhanced Recovery After Surgery (ERAS) programs. The purpose of these quality programs is to optimize interventions during perioperative care and reduce postoperative complications. Nevertheless an increase of evidence of the effectiveness, implementing these guidelines remains difficult.

A recent review also showed a large variation between the care processes for colorectal surgery. Therefore, a standard approach was developed for these patients. This evidence-based model provides a good basis for local teams who want to improve the care for colorectal surgery. In addition, the European Pathway Association (E-P-A) conducted an international multicenter study in 12 hospitals spread over 4 countries (Belgium, Netherlands, Germany and France). An internal report shows that only 44% of the ERAS guidelines are followed in hospitals, which has a negative impact on quality of care. A method of implementing such programs successfully and improving care step by step is through the Breaktrough Improvement Collaborative (BIC) method. Initiative enhancements are best done when the current care card is listed, when barriers and facilitation factors are identified and if you, as a group of hospitals, start the learningprocess together. Through the BIC method, a group of hospitals can be supported to strive for centers of excellence. Recent research has already shown what potential barriers and facilitation factors may be in the implementation of ERAS guidelines.

Possible facilitating factors are:

• The presence of prior knowledge about ERAS within the hospital
• Good collaboration between team members
• Bottum up approach
• an ERAS coordinator
• continuous measurement of performance

Potential barriers are:

• Resistance of certain individuals within the team
• limited resources,
• Patient characteristics (such as comorbidities, complex surgery, but also unrealistic expectations of the patient due to poor information)

The goal is based on this evidentiary; and with the already known barriers, facilitators and experiences in hospitals; to facilitate a successful and sustainable implementation of the guidelines.