AIM. Evaluation of the results of the implementation of ERP in practice. MATERIALS AND METHODS. Two consecutive series of patients were analyzed. The first cohort was recruited in 2013-2015 (n=124), the second - in 2015-2017 (n=152). Patients were randomized into groups with traditional management and ERP. The postoperative complications, length of stay (LOS) and program adherence were estimated. RESULTS. There was no difference in complication rate in first and second series, and between groups. The postoperative length of stay in the first cohort of patients with ERP was 4.7±0.1, in the second - 5.8±0.2 days (p=0.0003). Age and comorbidity rate did not affect the outcomes of treatment. The factor associated with doctor was significant in terms of discharge. The postoperative LOSin patients with traditional management decreased from 9±0,6 to 7,8±0,3 (p=0,046) with implementation of ERP. CONCLUSION. ERP reduces the postoperative length of stay and does not affect the postoperative complications. This Protocol is doctor-dependent. The implementation of ERP improves the results of treatment for all patients in the clinic.
operative complications and mortality. Person-centred care has been shown to improve concordance between care provider and patient on treatment plans, improve health outcomes and enhance the patient experience. Methods: A patient education programme was developed for patients and carers; delivery of this is tailored to meet individual patient needs. The ERAS education programme also extends to a range of healthcare professionals as they all have apart to play in the patient's journey. The staff education programme targets teams from pre-operative assessment, critical care and the ward and aims to reinforce the principles of ERAS from day 0 to supported early discharge. The ERAS nurse is pivotal in the educational programmes. Additional methods include; cohorting patients together for group support, using visual reminders to promote ERAS principles, DVDs, information booklets, walkway signage, 'what matters to me' boards in patients rooms, sharing targets, goal setting exercises and involving family and carers in care plans and discharge planning. Results: Patient experience data was gathered from patient stories and feedback from discharge questionnaires and the results were displayed in the form of 'You Said e We Did' ward information boards. Data from ERAS performance markers such as length of stay, early mobilisation and time taken to return to normal eating and drinking demonstrate compliance factors that influence patient outcomes and satisfaction. Conclusion: The principles of person-centred care are inherent within the ERAS programme and require added focus and exploitation to manage patient expectations achieve better outcomes and improve patient experience.
The majority of surgeons are ready to apply ERP. Some elements are difficult to apply for use in real healthcare. More educational activities are needed for wider and complete use of the protocol. New scientific available data should be used to improve this approach.
AIM: to evaluate the cost-effectiveness of the enhanced recovery program (ERP).PATIENTS AND METHODS: a randomized clinical trial was carried out. A total of 152 patients were divided into ERP (n = 77) and conventional (n = 75) groups. To study the cost-effectiveness of ERP, direct medical costs were assessed at all stages of treatment (outpatient, inpatient, and also within 30 days after discharge from the hospital). Cost minimization analysis (CMA) was used.RESULTS: the median total costs at the stage of outpatient check-up ERP and conventional groups where comparable (33115-35146 rubles; p = 0.1). The total cost of inpatient treatment in the main group was 175,535 rubles, in the control group — 199,055 rubles (p < 0.0001). The costs of outpatient follow-up in ERP group were significantly higher compared to the conventional group (p = 0.0005). The difference, according to Hodges-Lehmann estimation, was 940.7 rubles. The cost of the entire cycle of treatment in the ERP group was 214805 rubles, in the conventional — 237890 rubles (p < 0.0001). Thus, the total reduction in treatment costs associated with ERP amounted to 23,085 rubles (9.7% expenditures)CONCLUSION: a cost-effectiveness analysis of the implementation of the Enhanced Recovery Program showed an overall cost reduction of 9.7% due to a reduction in costs at the inpatient stage.
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