66 Background: Enhanced recovery programs (ERPs) apply multi-modal approaches to manage symptoms, decrease complications, and reduce length of stay (LOS). Widely adopted in surgical settings, there is limited evidence of their implementation in non-surgical patient cohorts. An ERP was implemented in a medical oncology population at a National Cancer Institute-designated comprehensive cancer center. The aim of this quality improvement initiative was to evaluate the implementation of an enhanced recovery framework and determine feasibility in medical oncology. Methods: Enhanced recovery in medical oncology (ERMO) was implemented using Plan, Do, Study, Act methodology. Implementation included introduction of integrative medicine, opioid sparing alternatives, fluid and nutrition management, and functional mobility. Outcome measures included symptom distress as measured by the Edmonton Symptom Assessment Scale (ESAS), return to intended oncologic therapy (RIOT), LOS, and opioid use, evaluated from January 2017 through April 2018. Results: A total of 50 patients were evaluated during the program implementation, and compared with 49 control patients retrospectively reviewed prior to ERMO implementation. Average LOS for ERMO patients was 7.3 days compared to 5.5 days for the control group. Time to RIOT averaged 18.9 days for control patients (n = 30) versus 20.8 days for ERMO patients (n = 17). Nineteen patients (38%) had a reduction in morphine equivalent daily dose (MEDD) from admission to discharge, with an average MEDD of 328.47 milligrams per patient. Conclusions: ERMO as a framework is feasible. The patient reported outcomes such as ESAS and RIOT, and barriers to implementation, including participant engagement and patient pain management perceptions, should be evaluated in the context of larger clinical trials.
The research was completed in four main stages: 1. The literature about earthquakes and emergencies was studied. The relevant information was divided into sub-subjects. 2. A model that would examine the level of preparedness of the emergency services in the country was constructed. The model is based on a number of models for populations dealing with emergencies, which had been constructed by the Home Front Command and validated by experts. The level of preparedness was examined by conducting in-depth interviews with experts in the fields of emergencies and earthquakes, and by conducting quantitative surveys with a representative sample of the relevant researched population. A total of 532 managers in the emergency and rescue organizations, 505 adults, and a random sample of 2,648 fifth and sixth grade students was surveyed. 3. Based on the results of the examination of the level of preparedness, a national, multi-organizational model for saving lives at the preparedness and first response stages after an earthquake was constructed. 4. Seniors and experts on the subject were surveyed using questionnaires and interviews. With these data, the national model was validated using the Delphi method. During this stage, the model was updated twice.
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