Cardiac Enhanced Recovery After Surgery: A Guide to Team Building and Successful Implementation

Salenger, Rawn; Morton-Bailey, Vicki; Grant, Michael C.; Gregory, Alexander J.; Williams, Judson B.; Engelman, Daniel T.

doi:10.1053/j.semtcvs.2020.02.029

Cited by 49 publications

(20 citation statements)

References 13 publications

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“…Previous publications have outlined the ideal strategy for implementing a comprehensive cardiac ERP. [17][18][19][20][21] The recommended process generally consumes a high degree of time, resources, effort, enthusiasm, and acceptance of change in current practices at start-up, with the offsetting gains realized once adoption is complete. Meanwhile, hospitals are full and resources are stretched thin.…”

Section: Cardiac Enhanced Recovery In the Era Of Covid-19mentioning

confidence: 99%

“…Audit is the foundation of enhanced recovery, providing measurements of protocol adherence and patient outcomes. 8,21 After implementation, an audit will assist in identifying areas of poor protocol adherence, root cause analysis, and adjustment of the protocol or further healthcare provider education as needed. Auditing key outcomes will spotlight "wins" while also directing attention to areas that need greater attention and improvement.…”

Section: Step 3: Plan and Develop The Erp Protocolmentioning

confidence: 99%

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Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Gregory

Grant²,

Boyle

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Cardiac Enhanced Recovery In the Era Of Covid-19mentioning

confidence: 99%

Section: Step 3: Plan and Develop The Erp Protocolmentioning

confidence: 99%

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Gregory

Grant²,

Boyle

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

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“…However, a step-by-step approach to implementing and maintaining compliance with anesthesia bundles in large anesthesia practices has not been thoroughly described. [12][13][14][15] As part of a quality improvement project, in March of 2018, an Enhanced Recovery After Surgery pathway for laparoscopic, vaginal, and open hysterectomy patients called "ERAS Hysterectomy" was implemented at the Massachusetts General Hospital. This pathway was designed by surgeons and anesthesiologists and utilized the Consolidated Framework For Implementation Research (CFIR) framework to implement evidence-based clinical care.…”

Section: Introductionmentioning

confidence: 99%

Implementing ERAS: how we achieved success within an anesthesia department

et al. 2021

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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.

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“…In recent years, the application scope of enhanced recovery after surgery(ERAS) has become more and more extensive, and at the same time, it has been applied in many clinical departments including cardiothoracic surgery and has received good results [1,2]. Among them, pain management is an important aspect and requires anesthesiologists to actively participate in this important stage of postoperative recovery patients to improve the quality of postoperative recovery.…”

Section: Introductionmentioning

confidence: 99%

Oral Pregabalin in Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Wang

Dai

xingguo

et al. 2021

BioMed Research International

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Background. Pregabalin has received wide clinical attention as a new type of analgesic. We undertake a systematic review and meta-analysis to evaluate the effect of pregabalin on postoperative pain in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to July 2020) for eligible studies. The primary outcomes were the total morphine consumption at 24 h. A secondary outcome was intraoperative fentanyl consumption, extubation time postoperative, and length of stay in hospital. We calculated pooled weighted mean difference (WMD) or odds ratio (OR) and 95% CIs using random- or fixed-effects models. Results. Seven trials involving 463 patients were listed. Meta-analysis showed that the total morphine consumption at 24 h in the pregabalin group was significantly less than the control group (WMD: -5.44, 95% CI: -10.42–0.46, P = 0.03 ). We found that there is no significant difference between the two groups in intraoperative fentanyl consumption. Compared with the control group, the length of stay in hospital in the pregabalin group was significantly shorter (WMD = -0.87, 95% CI: -1.42−0.32, P = 0.002 ). And we found that there were no significant differences between the two groups in extubation time (WMD: 17.24, 95% CI: -24.36−58.84, P = 0.42 ). Conclusions. Oral pregabalin for cardiac surgery patients can effectively reduce the patient’s 24-hour morphine consumption after surgery, shorten the patient’s hospital stay, and is more conducive to early postoperative recovery.

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Cardiac Enhanced Recovery After Surgery: A Guide to Team Building and Successful Implementation

Cited by 49 publications

References 13 publications

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes

Implementing ERAS: how we achieved success within an anesthesia department

Oral Pregabalin in Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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