scholarly journals Implementing ERAS: how we achieved success within an anesthesia department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dan B. Ellis ◽  
Aalok Agarwala ◽  
Elena Cavallo ◽  
Pam Linov ◽  
Michael K. Hidrue ◽  
...  
Keyword(s):  
General Hospital ◽  
Residency Program ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Massachusetts General Hospital ◽  
Educational Interventions ◽  
Nurse Anesthetists ◽  
Intervention Period ◽  
Post Intervention ◽  
Anesthesia Group

Abstract 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.

scholarly journals Types of surgical patients enrolled in enhanced recovery after surgery (ERAS) programs in the USA

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sunitha M. Singh ◽  
Asha Liverpool ◽  
Jamie L. Romeiser ◽  
Julie Thacker ◽  
Tong J. Gan ◽  
...  
Keyword(s):  
San Francisco ◽  
Residency Program ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Positive Association ◽  
Surgical Oncology ◽  
Surgical Service ◽  
Significant Positive Association ◽  
The Usa ◽  
Surgery Residency Program

Abstract Background Enhanced Recovery After Surgery (ERAS) programs have gained traction across US hospitals in the past two decades. Initially implemented for elective colorectal surgical procedures, ERAS has expanded to a variety of surgical service lines. There is little information regarding the extent to which various surgical service lines use ERAS. Methods A survey was performed to describe the prevalence of ERAS programs across surgical service lines in the USA. The survey had questions regarding the number of ERAS programs, operating rooms (ORs) and presence of anesthesia and/or surgery residency program at an institution. The survey was administered electronically to members of the American Society for Enhanced Recovery (ASER) and manually to participants at the 2018 Perioperative Quality and Enhanced Recovery Conference in San Francisco, CA. Results Responses were received from 88 unique institutions. The most commonly reported surgical service lines were colorectal (87%), gynecology (51%), orthopedic (49%), surgical oncology (39%), and urology (35%). A significant positive association was observed between the number of ORs and the number ERAS programs (Spearman’s Rho 0.5, p<0.0001). Furthermore, institutions that reported an anesthesia and/or surgery residency program had more ERAS programs (mean 5.0 ± 3.2) compared to those that did not (mean 2.0 ± 2.0) (Wilcoxon rank sum p< 0.001). Conclusions ERAS has expanded to a large extent outside of the colorectal surgery service line with increases notable in orthopedic surgery, obstetric/gynecology, surgical oncology, and urology procedures. Institutions with a higher number of ORs and the presence of an anesthesia and/or surgery residency program are associated with an increased number of ERAS programs.

Acute Diarrhoea Management in Emergency; Influencing Antibiotic Prescribing Patterns

Med Phoenix ◽  
2017 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Mohammed Mansuri Islam ◽  
Md. Parwez Ahmad ◽  
Akhtar Alam Ansari ◽  
Tarannum Khatun ◽  
Mohammad Ashfaque Ansari ◽  
...  
Keyword(s):  
Acute Diarrhoea ◽  
Educational Interventions ◽  
High Rate ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
Post Intervention ◽  
Emergency Case ◽  
Clinical Criteria ◽  
Prescribing Behaviour

Background: Medical students are taught the internationally accepted approach to acute diarrhoea, viz. adequate fluid and electrolyte replacement is the fundamental management of acute diarrhoea. Antibiotics should be restricted to specific indications, such as acute dysentery. Despite the well known rationale, there has been a high rate of prescription of antibiotics for acute diarrhoea presenting to Emergency.Methods: The pre and post intervention data was collected in the following way. All Emergency case records were routinely scrutinized in the Dept of Family Medicine after discharge with the exception of cases that were admitted to the wards. All cases with a discharge diagnosis fitting the clinical criteria of acute diarrhoeal syndrome: diarrhoea, gastroenteritis, dysentery and cholera were separated, analysed and recorded sequentially.Results: Initially doctors were prescribing  antibiotics for 52.8% of case of non-bloody diarrhoea. In the 2nd intervention period there were few cases, but it is remarkable how few were prescribed antibiotic (20%) while the survey of prescribing habits was underway. In the 3rd intervention period when an education event took place, it was the peak of the diarrhea season. Prescribing increased somewhat to 29%. In the 4th intervention a letter was sent out to the doctors describing the results so far, and pointing out the lower prescribing by “senior doctors”. The overall changes in prescribing behaviour after the educational interventions were statistically significant. The reduction in prescribing noted when comparing intervention 1 and intervention 4, is highly significant (antibiotic p < 0.0001, anti-protozoal p<0.0001). In the 5th intervention period when appropriate prescribing was no longer actively promoted, the rate of prescribing increased again to 41.4% of cases. A similar pattern is noted for antiprotozoal prescribing. The increase in prescribing noted in the 5th period was still less than in the 1st period (antibiotic p=0.041, anti-protozoal p=0.055). The increase in prescribing from periods 4 to 5 was significant. (Antibiotics p<0.0001, anti-protozoal p = 0.012).Med Phoenix Vol.2(1) July 2017, 12-17 

Enhanced Recovery After Surgery at Howard County General Hospital: A Multidisciplinary and Collaborative Initiative

2021 ◽  
Vol 36 (4) ◽  
pp. e14-e15
Author(s):  
Team Leaders: Hadley Wesson ◽  
Mary Christina Joy Lazo ◽  
Team Members: Yee-Wen Shyu ◽  
Cindy You ◽  
Ellen Yutuc
Keyword(s):  
General Hospital ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Collaborative Initiative

scholarly journals Pre-Operative Enhanced Recovery After Surgery (ERAS) Protocol Compliance Towards Major Surgery Patients at Dr. Soetomo General Hospital, Surabaya

2020 ◽  
Vol 3 (1) ◽  
pp. 28
Author(s):  
Ahmad Sabili Rifa'i ◽  
Gadis Meinar Sari ◽  
Vicky Sumarki Budipramana
Keyword(s):  
General Hospital ◽  
Cardiovascular Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Patients ◽  
Gynecologic Surgery ◽  
Major Surgery ◽  
Gynecological Surgery ◽  
Digestive Surgery ◽  
Eras Protocol

Introduction: The implementation of ERAS protocol can optimize patients after surgery, which in turn can reduce burdens both for patient and hospital. The purpose of this study is to describe the compliance and consistency of ERAS in the pre-operative period of surgery patients in Dr. Soetomo General Hospital Surabaya. Methods: We conducted consecutive observation of major surgical patients for 4 weeks. The type of surgery observed was digestive, thoracic and cardiovascular, and gynecological surgery. The pre-operative period will be calculated for compliance based on the ERAS international protocol. All data of compliance presented descriptively.s.Results: A total of 36 major surgery patients of which 7 (19,4%) were digestive surgeries, 14 (38,9%) were thoracic and cardiovascular surgeries, and 15 (41,7%) were gynecological surgeries. Overall compliance of the ERAS protocol in the pre-operative period of major surgery patients was 91%. The compliance of ERAS protocol in the pre-operative period of digestive surgery patients was 80%, in thoracic and cardiovascular surgery patients was 93,4% and gynecologic surgery patients was 84.3%. Major surgery patients with ≥90% compliance was 25%. Digestive surgery patients with ≥90% compliance was 0%. Thoracic and cardiovascular surgery patients with ≥90% compliance was 64,3%. Gynecologic surgery patients with ≥90% compliance was 0%.Conclusion: : Pre-operative elements of ERAS protocol in major surgery including digestive, thoracic and cardiovascular, and gynecologic surgery in Dr. Soetomo General Hospital, Surabaya needs to be improved.

Heat-Etching with a Bullivant Type II Simple Freeze-Cleave Device

1970 ◽  
Vol 28 ◽  
pp. 106-107 ◽  
Author(s):  
Ronald S. Weinstein ◽  
N. Scott McNutt
Keyword(s):  
New Zealand ◽  
General Hospital ◽  
Massachusetts General Hospital ◽  
Type I ◽  
Type Ii ◽  
Collaborative Effort ◽  
Temperature And Pressure ◽  
The University

The Type I simple cold block device was described by Bullivant and Ames in 1966 and represented the product of the first successful effort to simplify the equipment required to do sophisticated freeze-cleave techniques. Bullivant, Weinstein and Someda described the Type II device which is a modification of the Type I device and was developed as a collaborative effort at the Massachusetts General Hospital and the University of Auckland, New Zealand. The modifications reduced specimen contamination and provided controlled specimen warming for heat-etching of fracture faces. We have now tested the Mass. General Hospital version of the Type II device (called the “Type II-MGH device”) on a wide variety of biological specimens and have established temperature and pressure curves for routine heat-etching with the device.

Psychological influences on wound healing

2019 ◽  
Vol 98 (8) ◽  
pp. 312-314
Keyword(s):  
Wound Healing ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
State Of Mind ◽  
Life Threatening ◽  
Psychological Influences ◽  
Fear And Anxiety ◽  
Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

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