Widener University School of Nursing, Chester, Pennsylvania, USA.
JBI Evid Implement. 2021 Mar;19(1):39-55. doi: 10.1097/XEB.0000000000000250. Epub 2020 Sep 8.
The goal of this implementation project was to improve postoperative outcomes in the Day Surgery Podiatric patient population with the implementation of an enhanced recovery after surgery (ERAS) protocol at a large urban health system in the northeastern United States. We aimed to improve postoperative patient pain scores and reduce patient length of stay (LOS) with the implementation of the podiatric ERAS protocol (PEP).
ERAS provides an evidence-based interdisciplinary approach to the preparation and care of surgical patients. The core goals of ERAS promote accelerated patient recovery after surgery by incorporating broad patient education with strategies to reduce the physiologic stress associated with surgery and anesthesia. This strategy has been applied to many major surgical specialties but has not been established in podiatric patients.
The PEP evidence implementation initiative integrates two Joanna Briggs Institute tools: the Getting Research into Practice audit and feedback tool, and Practical Application of Clinical Evidence System, by incorporating proactive planning and data analyses. Baseline electronic health record data were collected in July 2019, followed by interdisciplinary PEP review, revision, implementation, and three data collection cycles. Strategic education was provided to stakeholders throughout data collection cycles.
This use of ERAS in the outpatient podiatric surgery population demonstrated excellence in compliance with best practice recommendations. The proactive multimodal approach of PEP revealed improvement in four measures of patient pain, with improvement from 83 to 100% of patients having a pain goal higher than their admission postoperative pain score. Patient pain goal greater than discharge pain score was also found but not sustained. Baseline data collection established that 29% of podiatric patients had a LOS less than 90 min, which improved to 42% with PEP. This finding was also not sustained in the third cycle of audit data. Missing data may have influenced these results, reinforcing the need for further study.
The use of ERAS in orthopedic patients has an established empirical basis for use, demonstrating a reduction in both postoperative pain and LOS. This novel use of ERAS in a podiatric surgery outpatient population has similar findings but was not sustained in all audit criteria. PEP demonstrated promising reductions in postoperative pain and LOS; however, further implementation replication is needed to confirm this expansion of ERAS and the promising results.
本实施项目的目标是通过在美国东北部一家大型城市卫生系统实施增强术后康复（ERAS）方案，改善日间手术足病患者的术后结局。我们旨在通过实施足病 ERAS 方案（PEP）来改善术后患者的疼痛评分并缩短患者的住院时间（LOS）。
ERAS 提供了一种基于证据的多学科方法，用于准备和护理手术患者。ERAS 的核心目标是通过广泛的患者教育以及减少与手术和麻醉相关的生理应激的策略，促进手术后患者的快速康复。这种策略已应用于许多主要的外科专业，但尚未在足病患者中确立。
PEP 证据实施计划整合了 Joanna Briggs 研究所的两个工具：获取研究到实践审核和反馈工具，以及临床证据系统的实际应用，通过整合主动规划和数据分析。在 2019 年 7 月收集基线电子健康记录数据，随后进行跨学科 PEP 审查、修订、实施和三个数据收集周期。在数据收集周期中向利益相关者提供战略教育。
在门诊足病手术患者中使用 ERAS 证明了在遵守最佳实践建议方面的卓越表现。PEP 的主动多模式方法显示出患者疼痛四项指标的改善，与入院后疼痛评分相比，有 83%至 100%的患者的疼痛目标更高。也发现了患者的疼痛目标大于出院疼痛评分，但未持续。基线数据收集确立了 29%的足病患者的 LOS 小于 90 分钟，而使用 PEP 后改善到 42%。在第三次审核数据周期中，这一发现也没有持续。缺失数据可能影响了这些结果，这也强调了进一步研究的必要性。
在骨科患者中使用 ERAS 有其既定的实证基础，可减少术后疼痛和 LOS。在足病手术门诊患者中使用这种新的 ERAS 方法也有类似的发现，但在所有审核标准中都没有持续。PEP 显示出在术后疼痛和 LOS 方面有希望的降低；然而，需要进一步的实施复制来确认这一 ERAS 的扩展和有希望的结果。
