scholarly journals Systematic Review: Enhanced Recovery After Cholecystectomy Surgery

2019 ◽  
Author(s):  
Meghan Cole
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Improve Patient Care ◽  
Healthcare Spending ◽  
Patient Centered ◽  
Systems Model ◽  
Lengths Of Stay ◽  
Improve Patient

This systematic review aimed to answer the clinical question, which perioperative enhanced recovery after surgery (ERAS) techniques are most effective in decreasing recovery time and length of stay for adults, aged 18-65, undergoing cholecystectomy surgery? In an effort to curb healthcare spending, ERAS is one way to reduce hospital- associated costs. Originally developed in Denmark, ERAS is a patient-centered initiative that aims to reduce the body’s stress response, leading to improved patient outcomes and decreased hospital lengths of stay. Betty Neuman’s Systems Model was used as a theoretical framework to enrich the understanding of enhanced recovery and how it works to improve patient care.

scholarly journals Does Implementation of Enhanced Recovery after Surgery (ERAS) Protocols in Colorectal Surgery Improve Patient Outcomes?

2019 ◽  
Vol 32 (02) ◽  
pp. 109-113 ◽  
Author(s):  
Julia Berian ◽  
Clifford Ko ◽  
Kristen Ban
Keyword(s):  
Colorectal Surgery ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Process Measures ◽  
Improved Outcomes ◽  
Preoperative Carbohydrate Loading ◽  
Eras Protocol ◽  
Implementation Data ◽  
Improve Patient

AbstractEnhanced Recovery after Surgery (ERAS) protocols are multimodal perioperative care pathways designed to accelerate recovery by minimizing the physiologic stress of a surgical procedure. Benefits of ERAS implementation in colorectal surgery include reduced length of stay and decreased complications without an increase in readmissions. Though there is evidence associating individual ERAS protocol elements (e.g., preoperative carbohydrate loading, judicious perioperative fluid administration, and early initiation of postoperative nutrition) with improved outcomes, ensuring high compliance with all elements of an ERAS protocol will maximize benefits to the patient. After ERAS implementation, data collection on protocol process measures can help providers target education and interventions to improve protocol compliance and patient outcomes.

scholarly journals The Quality Improvement Challenge—How Nurses and Allied Health Professionals Can Solve the Knowing–Doing Gap in Enhanced Recovery after Surgery (ERAS)

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 652
Author(s):  
Thomas W. Wainwright
Keyword(s):  
Quality Improvement ◽  
Six Sigma ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Improve Patient Care ◽  
Allied Health Professionals ◽  
Widespread Implementation ◽  
Total Knee ◽  
Improve Patient ◽  
English National Health

The English National Health Service (NHS), and all health services around the world, will continue to face economic and capacity challenges. Quality improvement (QI) interventions, such as Enhanced Recovery after Surgery (ERAS), that are proven to improve patient care and deliver operational benefits are therefore needed. However, widespread implementation remains a challenge. Implementation of ERAS within the NHS over the last 10 years is reviewed, with a focus on total hip arthroplasty (THA) and total knee arthroplasty (TKA). Difficulties with implementation are highlighted, and a recommendation for the future is presented. This perspective is novel in the ERAS literature, and centres around increasing the understanding of perioperative care teams on the need for utilising a recognised QI method (e.g., plan–do–study–act cycles, Lean, and Six Sigma) to implement ERAS protocols (which are a QI intervention) successfully. The importance of differentiating between a QI method and a QI intervention has value across all other ERAS surgical procedures.

scholarly journals Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery

2021 ◽  
Vol 10 (8) ◽  
pp. 1634
Author(s):  
Henry John Golder ◽  
Vassilios Papalois
Keyword(s):  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Goal Directed Fluid Therapy ◽  
Enhanced Recovery Pathways ◽  
Recovery Protocols ◽  
Recovery Pathways ◽  
Improve Patient

Enhanced recovery after surgery (ERAS) aims to improve patient outcomes by controlling specific aspects of perioperative care. The concept was introduced in 1997 by Henrik Kehlet, who suggested that while minor changes in perioperative practise have no significant impact alone, incorporating multiple changes could drastically improve outcomes. Since 1997, significant advancements have been made through the foundation of the ERAS Society, responsible for creating consensus guidelines on the implementation of enhanced recovery pathways. ERAS reduces length of stay by an average of 2.35 days and healthcare costs by $639.06 per patient, as identified in a 2020 meta-analysis of ERAS across multiple surgical subspecialties. Carbohydrate loading, bowel preparation and patient education in the pre-operative phase, goal-directed fluid therapy in the intra-operative phase, and early mobilisation and enteral nutrition in the post-operative phase are some of the interventions that are commonly implemented in ERAS protocols. While many specialties have been quick to incorporate ERAS, uptake has been slow in the transplantation field, leading to a scarcity of literature. Recent studies reported a 47% reduction in length of hospital stay (LOS) in liver transplantation patients treated with ERAS, while progress in kidney transplantation focuses on pain management and its incorporation into enhanced recovery protocols.

scholarly journals The Perioperative Surgical Home in Pediatrics: Improve Patient Outcomes, Decrease Cancellations, Improve HealthCare Spending and Allocation of Resources during the COVID-19 Pandemic

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 258
Author(s):  
Aysha Hasan ◽  
Remy Zimmerman ◽  
Kelly Gillock ◽  
Richard H Parrish
Keyword(s):  
Patient Outcomes ◽  
Pediatric Patients ◽  
Enhanced Recovery ◽  
Surgical Care ◽  
Healthcare Spending ◽  
Perioperative Surgical Home ◽  
Standard Operating ◽  
Pediatric Populations ◽  
Improve Patient

Cancellations or delays in surgical care for pediatric patients that present to the operating room create a great obstacle for both the physician and the patient. Perioperative outpatient management begins prior to the patient entering the hospital for the day of surgery, and many organizations practice using the perioperative surgical home (PSH), incorporating enhanced recovery concepts. This paper describes changes in standard operating procedures caused by the COVID-19 pandemic, and proposes the expansion of PSH, as a means of improving perioperative quality of care in pediatric populations.

scholarly journals A systematic review of enhanced recovery after surgery for vascular operations

2019 ◽  
Vol 70 (2) ◽  
pp. 629-640.e1 ◽  
Author(s):  
Katharine L. McGinigle ◽  
Jens Eldrup-Jorgensen ◽  
Rebecca McCall ◽  
Nikki L. Freeman ◽  
Luigi Pascarella ◽  
...  
Keyword(s):  
Systematic Review ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

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