Implementing ERAS: how we achieved success within an anesthesia department

Abstract

Background The Massachusetts General Hospital is a large, quaternary care institution with 58 operating rooms, 164 anesthesiologists, 76 certified nurse anesthetists (CRNAs), an anesthesiology residency program that admits 25 residents annually, and 35 surgeons who perform laparoscopic, vaginal, and open hysterectomies. In March of 2018, our institution launched an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing hysterectomy. To implement the anesthesia bundle of this pathway, an intensive 14-month educational endeavor was created and put into effect. There were no subsequent additional educational interventions. Methods We retrospectively reviewed records of 2570 patients who underwent hysterectomy between October 2016 and March 2020 to determine adherence to the anesthesia bundle of the ERAS Hysterectomy pathway. RESULTS: Increased adherence to the four elements of the anesthesia bundle (p < 0.001) was achieved during the intervention period. Compliance with the pathway was sustained in the post-intervention period despite no additional actions. Conclusions Implementing the anesthesia bundle of an ERAS pathway in a large anesthesia group with diverse providers successfully occurred using implementation science-based approach of intense interventions, and these results were maintained after the intervention ceased.

Ultrasound Image under Artificial Intelligence Algorithm to Evaluate the Intervention Effect of Accelerated Rehabilitation Surgery Nursing on Laparoscopic Hysterectomy

“…However, the contrast and resolution of the ISCB algorithm are just the opposite, and the difference is significant ( P < 0.05). It indicates that the ISCB algorithm successfully corrects the error of guidance vector and performs well in anti-interference, imaging contrast, and resolution [ 21 ]. Compared with the pelvic floor ultrasound imaging effect, the ISCB algorithm has few ultrasound image artifacts and low side lobes, and the overall quality is better than the SCB algorithm, SER algorithm, and RLS algorithm, which corresponds to the above quantitative data results.…”

Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

“…The lack of repeated education on ERAS protocols has a significant influence on compliance, as well as analyzing the obstacles and catalysts to implementation and compliance. Every participant needs to know the implementation of ERAS protocols can be challenging, but ultimately rewarding [ 38 ].…”

Enhanced Recovery After Surgery Patients Are Prescribed Fewer Opioids at Discharge

“…ERAS was implemented in an iterative fashion by service line at this institution starting with colorectal surgery in 2014. 14 Colorectal surgery patients were not included in this analysis, as ERAS was initiated before an electronic medical record implementation at this institution. Therefore, baseline data were not available for colorectal patients.…”

“…ERAS is a multi-pronged, adaptable program that standardizes a set of preoperative preparatory steps, intraoperative fluid and analgesic targets, and postoperative management. [13][14][15][16][17] ERAS was originally described in the colorectal population 13,18 and has since been expanded widely to specialties including gynecologic surgery, 19 cardiothoracic surgery, 20 vascular surgery, 21 neurosurgery, 22 breast surgery, 23 hepatopancreaticobiliary (HPB) surgery, 24 and spine surgery. 25 ERAS implementation has demonstrated substantial reductions in postoperative infectious complications, length of stay, cost, and use of in-hospital opioids.…”