Role of Adherence to Enhanced Recovery After Surgery Programs in Mitigating Health Care Disparities

Rozental, Olga; White, Robert S.; Weinberg, Roniel

doi:10.1001/jamasurg.2019.3486

Cited by 13 publications

(9 citation statements)

References 5 publications

(14 reference statements)

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“…Standardization is in itself a virtue during a crisis: the CDC states that, "making decisions about ventilator distribution and triage using a standard framework for incident management creates a clear hierarchy of accountability and responsibility, facilitates consistent communication and helps minimize differential treatment of patients" [11]. Across medicine the use of standardized protocols has been shown to decrease medical provider implicit bias and has been shown to decrease healthcare disparities [39,40]. Crucially, a standardized document would also ensure that each hospital has a robust triage decisions appeals process in place, since the total immunity granted to healthcare workers and institutions by the EDTPA renders legal avenues of appeal moot.…”

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confidence: 99%

No protocol and no liability: a call for COVID crisis guidelines that protect vulnerable populations

2020

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The COVID-19 pandemic is revealing the unacceptable health disparities across New York City and in this country. The mortality rates of vulnerable and minority populations alone suggest a need to re-evaluate clinical decision making protocols, especially given the recently passed Emergency or Disaster Treatment Protection Act, which grants healthcare institutions full immunity from liability stemming from resource allocation/triage decisions. Here we examine the disparity literature against resource allocation guidelines, contending that these guidelines may propagate allocation of resources along ableist, ageist and racial biases. Finally, we make the claim that the state must successfully develop ones that ensure the just treatment of our most vulnerable.

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confidence: 99%

No protocol and no liability: a call for COVID crisis guidelines that protect vulnerable populations

2020

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“…16 However, the use of ERAS protocols as a practical solution to address perioperative disparities has been mostly limited to colorectal surgical populations (the first surgical populations that ERAS protocols were developed for) and remarkably few published ERAS studies have included racial-ethnic or other social determinants of health as variables of interest or as “adjustor” variables. 13 14…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery after Surgery for Cesarean Delivery: A Quality Improvement Initiative

et al. 2022

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Objective Enhanced recovery after surgery (ERAS) was developed as a way to standardize clinical care pathways and communication across multidisciplinary teams to improve patient recovery and reduce hospital length of stay (LOS). Our objective was to implement an ERAS protocol for cesarean delivery (ERAS-CD) and evaluate its efficacy in reducing LOS. Study Design An ERAS-CD program was implemented at our institution in October 2018. Patients undergoing scheduled and unscheduled CD were maintained on an ERAS pathway of care, which included preoperative hydration, standardized intraoperative protocols, and postoperative analgesic regimens as well as early feeding, urinary catheter removal, and ambulation. We compared LOS after delivery (calculated from time of delivery to discharge), readmission rates, health care disparities and postoperative opioid prescribing practices before (October 2017–September 2018) and after (November 2018–October 2019) ERAS implementation. We excluded any outliers, defined as a LOS >25 days. Continuous data are expressed as mean ± standard deviation. Student's t-test and Chi-square were used for statistical comparison with p <0.05 considered statistically significant. Results There were 1,729 patients who had a CD in the pre-ERAS group with a mean LOS after delivery of 3.32 ± 6.19 days. In the post-ERAS group, 1,753 women underwent CD with a mean LOS after delivery of 2.85 ± 5.79 days, a statistically significant difference from the pre-ERAS group (p <0.001). There was no difference in readmission rates between pre- and post-ERAS implementation groups (1.9 vs. 2.2%, p = 0.53). There was a reduction in health care disparities in postoperative LOS, when stratifying by race-ethnicity, and a reduction in opioid prescribing practices after the implementation of the program. Conclusion With the implementation of an ERAS-CD program, we achieved a reduced LOS, without increasing readmission rates, and saw a reduction in health care disparities and opioid dispensing. A shorter LOS could offer an enhanced patient experience, as well as improved and equitable perioperative outcomes. Key Points

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“…Anesthesiologists must remain mindful of patient-centered concerns and recognize their own implicit bias in treatment and medical decision-making. 59,62 Implicit bias training may help anesthesiologists recognize and reduce differential treatment in their clinical practice for those patient populations presenting for surgery.…”

Section: Clinical Care Pathwaysmentioning

confidence: 99%

“…Evidence-based ERAS elements 10,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. …”

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Closing the gap: Perioperative health care disparities and patient safety interventions

Rangrass,

Obiyo,

Bradley

et al. 2024

International Anesthesiology Clinics

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A main priority of today's health care system is addressing the contributions of systemic and structural factors to health care disparities. 1,2 Over several decades, research in health care disparities and health services has described how health care is organized, delivered, financed, and accessed and characterized how policies and interventions impact cost, quality, outcomes, and patient safety. Patient safety is founded on the principle that health care professionals are well intentioned but function within systems that can produce untoward effects for patients and populations. Patient safety, health, and health care disparities are inextricably linked. Therefore, exploring health care disparities in perioperative care, why they exist, and offering potential strategies to enhance equity is essential to improving patient safety. 3 Patient-centered care considers an individual's specific health needs and desired health outcomes and can serve as a path forward toward reducing disparate care. The way patients interact with clinicians and the health care system can significantly alter their perioperative trajectories. Anesthesiologists are uniquely involved in the entire spectrum of perioperative care, and patientcentered care remains a high priority in the management of pain and sequelae of anesthetic care.In this article, we will discuss evidence suggesting that racial and ethnic minorities receive differential anesthetic care relative to their white counterparts. Differential care is seen preoperatively during planning and medical optimization, intraoperatively in the choice of anesthetic technique, and postoperatively related to pain control and the management of unforeseen complications. We will then describe the individualclinician level (patient-centered) interventions and system-level (local, regional, and national) policies that can be implemented to reduce perioperative disparities.

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Role of Adherence to Enhanced Recovery After Surgery Programs in Mitigating Health Care Disparities

Cited by 13 publications

References 5 publications

No protocol and no liability: a call for COVID crisis guidelines that protect vulnerable populations

No protocol and no liability: a call for COVID crisis guidelines that protect vulnerable populations

Enhanced Recovery after Surgery for Cesarean Delivery: A Quality Improvement Initiative

Closing the gap: Perioperative health care disparities and patient safety interventions

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