Leveraging Nursing Assessment for Early Identification of Post Operative Gastrointestinal Dysfunction (POGD) in Patients Undergoing Colorectal Surgery

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study presents a valuable initiative to improve the identification and management of post-operative gastrointestinal dysfunction (POGD) through the implementation of the I-FEED scoring system and abdominal percussion into nursing workflows. The training of nurses and subsequent evaluation through a survey demonstrate a well-organized approach. However, there are a few areas that could benefit from further information.

1.      Patient Outcomes: While the confidence of nurses is a positive indicator, the study would benefit from including preliminary data on patient outcomes. Has there been any observable impact on recovery times, length of hospital stay, or patient satisfaction since the implementation of the I-FEED tool and abdominal percussion?

2.      Long-term Feasibility and Sustainability: It would be helpful to discuss plans for ensuring the long-term sustainability of this practice. Are there ongoing training sessions for new staff? How will adherence to the new assessment protocol be monitored and maintained?

Overall, this initiative shows great promise in improving the detection and management of POGD. Addressing the above points could enhance the clarity and impact of the study, making it a stronger candidate for adoption in clinical practice.

Author Response

Comment 1:

Patient Outcomes: While the confidence of nurses is a positive indicator, the study would benefit from including preliminary data on patient outcomes. Has there been any observable impact on recovery times, length of hospital stay, or patient satisfaction since the implementation of the I-FEED tool and abdominal percussion?

Response 1: Thank you for your question and comment. We did not measure any direct clinical outcomes during this project phase. As part of this ongoing initiative, we aim to conduct a prospective exercise to assess the congruency of findings between Nursing and Provider teams and, finally, validate and develop predictive analytical and clinical decision-support tools for managing Postoperative Gastrointestinal Dysfunction. 

Comment 2:

Long-term Feasibility and Sustainability: Are there ongoing education sessions for new staff, and how do you monitor compliance over time?

Response: Comprehensive abdominal examination has now become a routine part of Nursing examination protocols and is part of the new employee orientation package. 

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this important manuscript. Here are my comments and suggestions.

Line 25: Please remove ''in the field''

The conclusion is more extensive than the discussion.

In the conclusion, it is written, ''This would allow prompt intervention for POGD and potentially prevent unnecessary workups.''. Can the authors be more precise on what unnecessary workup could be prevented? If POGD is suspected it, in some ocasions, means earlier diagnostic workup or change in the therapy. 

Author Response

Comment 1: Remove " in the field " in line 25

Response: Removed. Thank you.

Comment 2: Conclusion is more extensive than discussion.

Response: Thank you for your comment. We have reorganized the discussion and conclusion. We have also highlighted another limitation which is the lack of data on nay improvements in clinical outcomes directly as a result of this study.

Comment 3: Can the authors be more specific on what un-necessary workup ? 

Response: Thank you for alerting on a confusing statement. We have corrected the language in lines 140, 149 and 150.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

All queries answered. No additional comments.