Enhanced surgical recovery programmes in the ICU

2016 ◽  
Author(s):  
Michael J. Scott ◽  
Monty Mythen
Keyword(s):  
Enhanced Recovery ◽  
Surgical Stress ◽  
Evidence Based ◽  
Local Policy ◽  
Key Factors ◽  
Optimal Outcomes ◽  
Early Return ◽  
Enteral Diet ◽  
Goal Directed Fluid Therapy ◽  
Evidence Based Care

Enhanced recovery programmes (ERPs) are evidence-based care pathways starting from the point of patient referral right through the peri-operative period until discharge home. The ERP aims to reduce surgical stress and enhance post-operative physiological function with resulting early return of enteral diet and mobilization to improve outcomes. There are 20 evidence-based elements, many of which are delivered by a multidisciplinary team. Many elements support a treatment intervention, but some aim to avoid an intervention, which can negatively impact on recovery. An ERP with good compliance has been shown to reduce length of stay and medical complications. Minimal access surgery, high quality analgesia, and goal-directed fluid therapy are key factors ensuring optimal outcomes. There has been successful adoption and transfer of enhanced recovery principles into many surgical specialties. There is wide variation in the use of critical care within ERPs depending on local policy and patient risk factors.

Introduction

2020 ◽  
pp. 1-34
Keyword(s):  
Primary Care ◽  
Learning Disability ◽  
Enhanced Recovery ◽  
First Century ◽  
Evidence Based ◽  
Advanced Practice ◽  
Face To Face ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways ◽  
Evidence Based Care

This chapter provides an overview of the origins of orthopaedic and trauma nursing and care of the orthopaedic patient along the lifespan from birth to death in the twenty-first century. It explores contemporary healthcare in the context of a shift away from hospital-based care to more services being delivered in the community and primary care. It also looks at new ways of delivering care such as fast-track, enhanced recovery pathways and virtual or non-face-to-face clinics. Special attention has been given to supporting the person with a learning disability within orthopaedic and trauma settings. This chapter provides an update on standards and competencies for advanced practice roles and competencies within the field to optimize evidence-based care.

scholarly journals Optimising real time clinical librarian support to enhance the evidence base in radiotherapy clinical protocols

2020 ◽  
Vol 43 (127) ◽  
Author(s):  
Carol-Ann Regan ◽  
Simon Goldsworthy ◽  
Jessica Pawley
Keyword(s):  
Real Time ◽  
Quality Function Deployment ◽  
Evidence Base ◽  
Evidence Based ◽  
Clinical Protocol ◽  
Optimal Outcomes ◽  
Percentage Difference ◽  
Novel Approach ◽  
Clinical Radiotherapy ◽  
Evidence Based Care

Clinical teams are professionally driven to adopt the latest evidence-based care ensuring optimal outcomes for patients. There can be delays in the latest evidence reaching practice. The radiotherapy multi-professional team in partnership with Clinical Librarians developed a lean process to undertake the real-time evidence-based live update of clinical radiotherapy protocols. Principles of Quality Function Deployment were deployed to create a lean process. The process was evaluated for the percentage difference to the radiotherapy protocol parameters over two years. Satisfaction of the live update was scored from 1: Very dissatisfied to 5: Very satisfied. Since 2014, 12 protocols have been through the process. The live update resulted in 80% of differences to the clinical protocol compared to the previous two years. Among 10 respondents, a mode of 5 was scored for satisfaction. This novel approach has been successful in providing a lean process ensuring that the latest evidence reaches radiotherapy practice.

Enhanced Recovery Pathways: Organization of Evidence-Based, Fast-Track Perioperative Care

2013 ◽  
Author(s):  
Liane S. Feldman ◽  
Gabriele Baldini ◽  
Lawrence Lee ◽  
Franco Carli
Keyword(s):  
Perioperative Care ◽  
Enhanced Recovery ◽  
Surgical Stress ◽  
Fluid Management ◽  
Mechanical Bowel Preparation ◽  
Care Plan ◽  
Evidence Based ◽  
Care Plans ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Enhanced recovery pathways (ERPs) are standardized coordinated, multidisciplinary perioperative care plans that incorporate evidence-based interventions to minimize surgical stress, improve physiologic and functional recovery, reduce complications, and thereby facilitate earlier discharge from the hospital. Several perioperative elements contribute to enhance surgical recovery. Preoperative elements include patient education, optimization of medical conditions and functional status, nutritional support, smoking cessation programs, minimization of preoperative fasting and preoperative carbohydrate drinks, avoidance of mechanical bowel preparation when not indicated, and avoidance of long-active sedatives as premedication. Intraoperative elements aim to attenuate the surgical stress response and include regional or local anesthesia; pharmacologic adjuvants, nonopioid analgesics, and maintaining normothermia; intravenous fluid management; and opting to favor small incisions when possible. Postoperative elements include considering multimodal analgesia (opioid-sparing strategies); encouraging early postoperative feeding; stressing the importance of early mobilization; restricting the unnecessary use of intravenous fluids, drains, and catheters; and instituting a discharge and follow-up plan for patients. Tables describe the evolution of intraoperative fluid management, organization of a multimodal perioperative care plan for a specific procedure or group of procedures; key elements to include in developing an ERP; sample multimodal perioperative care plans for elective colorectal resection, esophageal resection, and ambulatory laparoscopic cholecystectomy. This review contains 1 figure, 6 tables, and 319 references.

Enhanced Recovery Pathways: Organization of Evidence-Based, Fast-Track Perioperative Care

2013 ◽  
Author(s):  
Liane S. Feldman ◽  
Gabriele Baldini ◽  
Lawrence Lee ◽  
Franco Carli
Keyword(s):  
Perioperative Care ◽  
Enhanced Recovery ◽  
Surgical Stress ◽  
Fluid Management ◽  
Mechanical Bowel Preparation ◽  
Care Plan ◽  
Evidence Based ◽  
Care Plans ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Enhanced recovery pathways (ERPs) are standardized coordinated, multidisciplinary perioperative care plans that incorporate evidence-based interventions to minimize surgical stress, improve physiologic and functional recovery, reduce complications, and thereby facilitate earlier discharge from the hospital. Several perioperative elements contribute to enhance surgical recovery. Preoperative elements include patient education, optimization of medical conditions and functional status, nutritional support, smoking cessation programs, minimization of preoperative fasting and preoperative carbohydrate drinks, avoidance of mechanical bowel preparation when not indicated, and avoidance of long-active sedatives as premedication. Intraoperative elements aim to attenuate the surgical stress response and include regional or local anesthesia; pharmacologic adjuvants, nonopioid analgesics, and maintaining normothermia; intravenous fluid management; and opting to favor small incisions when possible. Postoperative elements include considering multimodal analgesia (opioid-sparing strategies); encouraging early postoperative feeding; stressing the importance of early mobilization; restricting the unnecessary use of intravenous fluids, drains, and catheters; and instituting a discharge and follow-up plan for patients. Tables describe the evolution of intraoperative fluid management, organization of a multimodal perioperative care plan for a specific procedure or group of procedures; key elements to include in developing an ERP; sample multimodal perioperative care plans for elective colorectal resection, esophageal resection, and ambulatory laparoscopic cholecystectomy. This review contains 1 figure, 6 tables, and 319 references.

scholarly journals Enhanced recovery after surgery: operation-related factors

2021 ◽  
Vol 64 (12) ◽  
pp. 806-812
Author(s):  
Dae Wook Hwang
Keyword(s):  
Perioperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Antimicrobial Prophylaxis ◽  
Early Mobilization ◽  
Evidence Based ◽  
Complication Rates ◽  
Related Factors ◽  
Urinary Drainage

Background: The enhanced recovery after surgery (ERAS) program, which has been recently introduced in the field of perioperative care, represents a multimodal strategy to attenuate the loss, and improve the restoration, of functional capacity after surgery. This program aims to reduce morbidity and enhance recovery by reducing surgical stress, optimizing pain control, and facilitating early resumption of an oral diet and early mobilization. Considering this perspective, protocols for enhanced recovery should include comprehensive and evidence-based guidelines for best perioperative care. Appropriate protocol implementation may reduce complication rates and enhance functional recovery and thereby reduce the duration of hospitalization.Current Concepts: In major abdominal surgeries, the recommended ERAS protocols involve common items such as preoperative counseling, preoperative optimization, prehabilitation, preoperative nutrition, fasting and carbohydrate loading, bowel preparation, thromboprophylaxis, antimicrobial prophylaxis, surgical access, drainage, nasogastric intubation, urinary drainage, early mobilization and prevention of postoperative ileus, postoperative glycemic control, and postoperative nutritional care. These items have been briefly reviewed with the relevant evidence.Discussion and Conclusion: ERAS is a comprehensive and evidence-based guideline for optimal perioperative care. Although a number of ERAS items still require high-level evidence through well-designed randomized controlled trials, the ERAS guidelines can serve as adequate recommendations for our practice. Thus, these items can be introduced and adopted with evidence. In addition, it is important to remove items that are not supported by evidence from routine procedures.

Factors Associated With Evidence-Based Care in Community-Based Child Psychotherapy

2010 ◽  
Author(s):  
Lauren Brookman-Frazee ◽  
Rachel A. Haine ◽  
Mary J. Baker-Ericzen ◽  
Ann F. Garland
Keyword(s):  
Child Psychotherapy ◽  
Evidence Based ◽  
Community Based ◽  
Factors Associated ◽  
Evidence Based Care

A LOOK INTO THE HISTORY OF THE PREPARATION OF LOCAL PROFESSIONALS IN THE INDUSTRY

2019 ◽  
Vol 26 (2) ◽  
pp. 4-8
Author(s):  
Toshkentboy Pardaev ◽  
◽  
Zhavli Tursunov
Keyword(s):  
Evidence Based ◽  
Local Policy ◽  
Soviet Government ◽  
Policy Makers ◽  
History Of

In the article : In the second half of the 20 century the process of preparation of local experts in South Uzbekistan industry changes in this field a clear evidence-based analysis of the problematic processes that resulted from the discriminatory policy toward the Soviet government-dominated local policy makers

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