Date of Award

Spring 5-8-2021

Document Type

DNP Project

Project Team Faculty Member

Dr. Annie Imboden

Project Team Faculty Member

Dr. Kevin Stein


surgery, quality of care, recovery, Strong for Surgery, ERAS, pre-surgical


Nearly one-third of hospitalized patients experience preventable harm or adverse effects related to the care they received, often due to preventable surgical complications. Thorough preoperative assessment and management of risk factors can lessen this risk. The purpose of this quality improvement project was to increase knowledge and prepare staff for use of the preoperative tool Strong for Surgery (S4S) in a general surgery clinic in a rural hospital in southern Illinois. Support for each of the key components of the Strong for Surgery pre-surgical checklist was reviewed in the literature; these include nutrition, smoking cessation, glycemic control, medication management, safe and effective pain management, prehabilitation, and delirium. The process of staff education began with an in-person introduction to the Strong for Surgery pre-surgical checklist followed by an online computer-based learning module. The learning module encompassed the entirety of the S4S checklist, rationales for use, and methods for implementation. Learning outcomes were measured by comparing scores of identical pre-assessment and post-assessment tests containing multiple choice, true/false, and select all that apply questions. Post-assessment score results of 20 participants increased by 35% compared to pre-assessment. This project provided education on the S4S pre-surgical checklist as the initial step for planned future implementation into the standard of care. The immediate impact was an improvement in knowledge about the checklist and staff roles related to integrating S4S into care. The long-term implications of this project are the potential for improved patient outcomes, such as decreases in mortality, morbidity, reoperation, and length of stay. Education and preparation for the planned implementation of the S4S checklist will lead to a smooth implementation process.

Key Words: surgery, quality of care, recovery, Strong for Surgery, ERAS, presurgical

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