Enhanced Recovery Program in the Ambulatory Surgery Setting

Joshi, Girish P.

doi:10.1007/978-3-030-19171-9_12

Cited by 1 publication

(3 citation statements)

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“…2,14–17 The application of enhanced recovery protocols in the ambulatory surgical setting is rare, and thus far appears to be limited to adult centers. 3–5,19,32,33…”

Section: Discussionmentioning

confidence: 99%

“…2,[14][15][16][17] The application of enhanced recovery protocols in the ambulatory surgical setting is rare, and thus far appears to be limited to adult centers. [3][4][5]19,32,33 A significant obstacle to overcome was a lack of ambulatory staff familiarity with enhanced recovery concepts. This was surmounted via frequent communications and education at staff meetings, posting of pertinent ERP publications, and displaying dynamic data as the project progressed.…”

Section: Discussionmentioning

confidence: 99%

“…18 Although ambulatory surgery represents 65% to 70% of all elective surgical procedures, the application of ERP protocols in the ambulatory setting are few. 19 Suggested outcome measures in this setting included unplanned hospital admission, readmission after discharge home, and delayed discharge and return to activities of daily living. Other measures include common perioperative morbidities (pain, nausea/vomiting, delirium), and surgical complications, such as bleeding and infections.…”

mentioning

confidence: 99%

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Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Martin

Chiem

Hansen

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Enhanced Recovery After Surgery (ERAS) was first established in 2001 focusing on recovery from complex surgical procedures in adults and recently expanded to ambulatory surgery. The evidence for ERAS in children is limited. In 2018, recognized experts began developing needed pediatric evidence. Center-wide efforts involving all ambulatory surgical patients and procedures have not previously been described. METHODS: A comprehensive assessment and gap analysis of ERAS elements in our ambulatory center identified 11 of 19 existing elements. The leadership committed to implementing an Enhanced Recovery Program (ERP) to improve existing elements and close as many remaining gaps as possible. A quality improvement (QI) team was launched to improve 5 existing ERP elements and to introduce 6 new elements (target 17/19 ERP elements). The project plan was broken into 1 preparation phase to collect baseline data and 3 implementation phases to enhance existing and implement new elements. Statistical process control methodology was used. Team countermeasures were based on available evidence. A consensus process was used to resolve disagreement. Monthly meetings were held to share real-time data, gather new feedback, and modify countermeasure plans as needed. The primary outcome measure selected was mean postanesthesia care unit (PACU) length of stay (LOS). Secondary outcomes measures were mean maximum pain score in PACU and patient/family satisfaction scores. RESULTS: The team had expanded the pool of active ERP elements from 11 to 16 of 19. The mean PACU LOS demonstrated significant reduction (early in phase 1 and again in phase 3). No change was seen for the mean maximum pain score in PACU or surgical complication rates. Patient/family satisfaction scores were high and sustained throughout the period of study (91.1% ± 5.7%). Patient/family and provider engagement/compliance were high. CONCLUSIONS: This QI project demonstrated the feasibility of pediatric ERP in an ambulatory surgical setting. Furthermore, a center-wide approach was shown to be possible. Additional studies are needed to determine the relevance of this project to other institutions.

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“…2,14–17 The application of enhanced recovery protocols in the ambulatory surgical setting is rare, and thus far appears to be limited to adult centers. 3–5,19,32,33…”

Section: Discussionmentioning

confidence: 99%