Study to Evaluate the Impact of the Recovery Pathway on Postoperative Leght of Stay in Coronary Artery Bypass Surgery

Count of time between admission to the intensive care unit and hospital discharge (in hours and days).

Incidence of key morbidities and mortality, including cardiac reoperation, deep sternal wound infection/mediastinitis, stroke, prolonged ventilation, renal failure, and death.

Quality of life assessed by SF-36 survey before surgery and 30 days after hospital discharge. Scores range from 0 to 100, with higher scores indicating better quality of life.

Assessment of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Scores range from 0 to 21 for both anxiety and depression subscales, with higher scores indicating greater levels of anxiety or depression.

Assessment of patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Incremental costs assessed through a detailed micro-costing analysis of preoperative, intraoperative, and postoperative phases. Costs will include hospital stay (ward and intensive care unit), multiprofessional care, medications (including blood transfusion), surgical room costs (surgery time and equipment), operational equipment, consumables, imaging exams, and medical supplies. Costs associated with readmissions within 30 days after discharge will also be included.

Assessment of healthcare professionals' training and behavioral changes using the four levels of the Kirkpatrick Evaluation Model:

Level 1 (Reaction): Assessed participant satisfaction/motivation via a 5-question Likert scale survey (3-point scale: strongly agree, partially agree, strongly disagree) at three time points: before the project, after training and five pilot cases, and after completing randomized recruitment.

Level 2 (Learning): Evaluated knowledge improvement through a questionnaire (7 multiple-choice questions and 3 true/false questions) at the same time points as Level 1.

Level 3 (Behavior): Measured adherence to protocol metrics after five pilot cases and at the conclusion of randomized recruitment. Minimum adherence target: 70%.

Level 4 (Results): Assessed project outcomes, specifically a 40% reduction in postoperative hospital stay with 70% protocol adherence at the end of randomized recruitment.

Evaluation of patient safety culture among healthcare professionals using the Hospital Survey on Patient Safety Culture (HSPSC), comprising 42 items across 12 dimensions:

Teamwork within units Organizational learning/continuous improvement Supervisor/manager expectations/actions promoting safety Hospital management support for patient safety Overall perception of safety Feedback and communication about error Communication openness Frequency of event reporting Teamwork across units Staffing Handoffs and transitions Non-punitive response to errors

Responses will be collected on a 5-point Likert scale ranging from "strongly disagree" or "never" to "strongly agree" or "always." Scores will be classified into three categories:

Strengthened areas (≥75% positive responses) Potential improvement areas (<75% and >50% positive responses) Fragile areas (≤50% positive responses)