Die Dynamik des deutschen Gesundheitssystems erfordert eine rasche Teamentwicklung – kolorektale Fast-Track-Implementierung als Prototyp mit steiler Lernkurve

Restructuring of the German healthcare system necessitates adjustments in quality assurance, cost reduction, shortened length of stay, and professional staff retention. The structured Fast Track Implementation (FTI) for colorectal surgery meets these requirements through interprofessional team development.Fast Track was implemented in a structured procedure over the course of one year at the participating clinics. Fast Track adherence (= process quality) and data on functional recovery, morbidity, and mortality (= outcome quality) were reflected back to the teams for the periods before (preFTI), during (FTI), and after (postFTI) FT implementation, respectively.In 7 clinics, 1,550 elective colorectal resections were performed. Fast Track adherence increased from 52 % before (preFTI) to 83 % during (FTI) and 87 % after (postFTI) the structured Fast Track implementation (p < 0.01). Before the FT implementation, the recovery of patients' physical autonomy took 5 days, compared to 4 days during and only 3 days after the implementation (p < 0.001). The postoperative length of stay was reduced from 7 days (preFTI) to 6 days and then to 5 days (postFTI; p < 0.001). The rate of general complications simultaneously decreased from 12.6 % (preFTI) and 8.1 % (FTI) to 6.1 % (postFTI; p < 0.001).The structured Fast Track implementation for elective colorectal resections leads to improved process and outcome quality with a steep learning curve and can be considered as a template for project-oriented team development in other medical fields as well.