A Guide to Implementing Enhanced Recovery After Surgery Protocols: Creating, Scaling, and Managing a Perioperative Consult Service

Cummings, Jared J.; Ehrenfeld, Jesse M.; McEvoy, Matthew D.

doi:10.1097/aia.0000000000000163

Cited by 2 publications

(2 citation statements)

References 41 publications

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“…Sustainability was achieved in optimization due to consistent use of established ERP pathways, use of patient education documents, and data collection tools to record clinical outcomes. This study supports previous findings from Cummings et al 20 and Gotlib Conn et al, 21 who stated that sustainability calls for conducive tailored education to be delivered at specific phases of the perioperative pathways. McDonald 22 also found that implementation of multidisciplinary educational ERPs focused on physiology of postoperative recovery and evidence of required interventions may improve overall understanding of enhanced recovery elements and secure long-term staff engagement.…”

Section: Discussionsupporting

confidence: 91%

“…[17][18][19] A qualitative process evaluation performed after a 2-year ERP implementation found that surgeons, nurses, and anesthesiologists may be hesitant to practice changes, which could hinder adoption of an ERP. 19 Cummings et al 20 reported that provider knowledge and attitudes, lack of resources, and inadequate enhanced recovery education may present barriers to effective implementation and sustainability of an ERP. Similar to previous research, results from this SWOT analysis suggest that personnel and teamwork weaknesses were affected by lack of staff time, role clarity, communication, and total buy-in from surgeons and anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

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Scaling an Enhanced Recovery Program to an Institution-Wide Initiative: It Takes a Village

Kruse

Recinos

Eska

et al. 2021

Quality Management in Health Care

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Background and Objective: With the inclusion of Enhanced Recovery Programs (ERPs) into routine clinical practice, scaling programs across an institution is important to drive sustainable change in a patient-centric care delivery paradigm. A review of ERP implementation within a large institution was performed to understand key components that hinder or facilitate success of scaling an ERP. Methods: From January 2018 to March 2018, a needs assessment was completed to review implementation of enhanced recovery across the institution. Implementation progress was categorized into one of 5 phases including Define, Implement, Measure, Analyze, and Optimize. Results: Only 25% of service line ERPs reached the optimization phase within 5 years. One hundred percent of respondents reported more strengths (n = 41) and opportunities (n = 41) than weaknesses or threats (n = 25 and 14, respectively). Commonly identified strengths included established enhanced recovery pathways, functional team databases, and effective provider education. Weaknesses identified were inconsistencies in data quality/collection and a lack of key personnel participation including buy-in and time availability. Respondents perceived the need for data standardization to be an opportunity, while personnel factors were viewed as key threats. Conclusion: Identification of strengths, weaknesses, opportunities, and threats could prove beneficial in helping scale an ERP across an institution. Successful optimization and expansion of ERPs require robust data management for continuous quality improvement efforts among clinicians, administrators, executives, and patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Scaling an Enhanced Recovery Program to an Institution-Wide Initiative: It Takes a Village

Kruse

Recinos

Eska

et al. 2021

Quality Management in Health Care

View full text Add to dashboard Cite

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Association between surgical wait time and hospital length of stay in primary total knee and hip arthroplasty

et al. 2021

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Aims In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip. Methods The study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary total knee and hip arthroplasties (TKA, THA) between 2011 and 2017. Patients waiting longer than the recommended 180 days Canadian national standard were compared to patients waiting equal or less than the standard WT. The primary outcome measure was acute LoS postoperatively. Secondarily, patient demographics, comorbidities, and perioperative parameters were correlated with LoS with multivariate regression. Results A total of 11,833 TKAs and 6,627 THAs were included in the study. Mean WT for TKA was 348 days (1 to 3,605) with mean LoS of 3.6 days (1 to 98). Mean WT for THA was 267 days (1 to 2,015) with mean LoS of 4.0 days (1 to 143). There was a significant increase in mean LoS for TKA waiting longer than 180 days (2.5% (SE 1.1); p = 0.028). There was no significant association for THA. Age, sex, surgical year, admittance from home, rural residence, household income, hospital facility, the need for blood transfusion, and comorbidities were all found to influence LoS. Conclusion Surgical WT longer than 180 days resulted in increased acute LoS for primary TKA. Meeting a shorter WT target may be cost-saving in a social healthcare system by having shorter LoS. Cite this article: Bone Jt Open 2021;2(8):679–684.

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A Guide to Implementing Enhanced Recovery After Surgery Protocols: Creating, Scaling, and Managing a Perioperative Consult Service

Cited by 2 publications

References 41 publications

Scaling an Enhanced Recovery Program to an Institution-Wide Initiative: It Takes a Village

Scaling an Enhanced Recovery Program to an Institution-Wide Initiative: It Takes a Village

Association between surgical wait time and hospital length of stay in primary total knee and hip arthroplasty

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