Proudfoot Suzanne, Bennett Brandon, Duff Simon, Palmer Julie
Projects and Campaigns Manager, Ko Awatea, Auckland.
Improvement Advisor, Improvement Science Consulting, Washington DC, USA.
N Z Med J. 2017 May 12;130(1455):77-90.
The National Orthopaedic Enhanced Recovery After Surgery (ERAS) Collaborative was launched in November 2013 to implement ERAS protocols for hip and knee total joint arthroplasty (TJA) and fractured neck of femur (NOF) in participating district health boards (DHBs) by December 2014. This paper reports on the results.
ERAS protocols were developed for hip and knee TJA and fractured NOF. Breakthrough Series collaborative methodology was used to implement the ERAS protocols in 18 DHBs. We collected monthly data on compliance with protocols and average length of stay (ALOS). Data were analysed using run charts and Shewhart control charts.
The national percentage of ERAS components achieved across all DHBs rose from 33% to 75% on the elective knee TJA pathway, from 31% to 78% on the elective hip TJA pathway and from 29% to 51% on the acute fractured NOF pathway. The ALOS for knee TJA reduced from 5.4 days to 4.5 days. The ALOS for hip TJA reduced from 5.1 days to 4.3 days. There was no change in the ALOS for fractured NOF.
The National Orthopaedic ERAS Collaborative increased uptake of ERAS protocols across all three pathways and decreased ALOS for the elective pathways among participating DHBs. There was no decrease in ALOS for the fractured NOF pathway. Collaborative improvement methodology can be used successfully to implement orthopaedic ERAS across New Zealand DHBs.
国家骨科术后加速康复（ERAS）协作项目于2013年11月启动，旨在到2014年12月在参与的地区卫生委员会（DHBs）中为髋关节和膝关节全关节置换术（TJA）以及股骨颈骨折（NOF）实施ERAS方案。本文报告结果。
为髋关节和膝关节TJA以及股骨颈骨折制定了ERAS方案。采用突破系列协作方法在18个DHBs中实施ERAS方案。我们每月收集方案依从性和平均住院时间（ALOS）的数据。使用运行图和休哈特控制图对数据进行分析。
在所有DHBs中，选择性膝关节TJA路径上ERAS组成部分的全国达成率从33%升至75%，选择性髋关节TJA路径上从31%升至78%，急性股骨颈骨折路径上从29%升至51%。膝关节TJA的ALOS从5.4天降至4.5天。髋关节TJA的ALOS从5.1天降至4.3天。股骨颈骨折的ALOS没有变化。
国家骨科ERAS协作项目提高了所有三条路径上ERAS方案的采用率，并缩短了参与的DHBs中选择性路径的ALOS。股骨颈骨折路径的ALOS没有降低。协作改进方法可成功用于在新西兰各DHBs中实施骨科ERAS。
