Pooya Shabnam, Johnston Kerri, Estakhri Pejmon, Fathi Amir
Department of Food Science and Nutrition, California State University, Fresno, CA.
Community Regional Medical Center, Fresno, CA.
J Perianesth Nurs. 2021 Oct;36(5):468-472. doi: 10.1016/j.jopan.2020.12.011. Epub 2021 May 5.
Enhanced recovery after surgery (ERAS) programs comprise bundles of evidence-based recommendations designed to reduce physiological stress and support early return of function after surgery. In this study, we sought to investigate the barriers and facilitators of successful implementation of ERAS in a major safety-net hospital.
Our ERAS program has been designed as a quality improvement pilot project in prospective fashion with a real-time feedback loop. The program is designed to address established culture of safety-net hospitals.
An extensive multidisciplinary team investigated the barriers to success for three different levels of program stakeholders: providers, patients, and the facility. After a systematic review of these barriers, solutions were offered and implemented in a multidisciplinary care model with special attention to outcomes and continuous feedback. The findings are summarized in a grid format for better understanding and implementation ease.
Patients (N = 198) were enrolled in an ERAS program in a nonrandomized fashion during the pilot period of October 2017 to August 2018. ERAS cohort of patients' outcomes were then compared with those of 20,328 non-ERAS patients. The ERAS group had less complication with shorter length of stay compared with their non-ERAS counterparts. Furthermore, it has cost less to take care of these patients. Interestingly, this decrease was not achieved by a reciprocal increase in subsequent readmission or reoperation rates.
Unique barriers exist when implementing an ERAS protocol in a safety-net hospital. These barriers can be overcome to improve the quality of care at a decreased cost. We have provided a grid to facilitate the implementation process.
术后加速康复（ERAS）方案包含一系列循证建议，旨在减轻生理应激并支持术后功能早日恢复。在本研究中，我们试图调查在一家大型安全网医院成功实施ERAS的障碍和促进因素。
我们的ERAS方案被设计为一个具有实时反馈回路的前瞻性质量改进试点项目。该方案旨在应对安全网医院既有的文化。
一个广泛的多学科团队调查了方案中三个不同层面利益相关者（提供者、患者和医疗机构）成功实施的障碍。在对这些障碍进行系统审查后，提出了解决方案并在多学科护理模式中实施，特别关注结果和持续反馈。研究结果以表格形式总结，以便更好地理解和便于实施。
在2017年10月至2018年8月的试点期间，198例患者以非随机方式纳入ERAS方案。然后将ERAS组患者的结果与20328例非ERAS患者的结果进行比较。与非ERAS组患者相比，ERAS组患者并发症更少，住院时间更短。此外，照顾这些患者的成本更低。有趣的是，这种降低并不是通过随后再入院率或再次手术率的相应增加来实现的。
在安全网医院实施ERAS方案时存在独特的障碍。这些障碍可以被克服，以降低成本提高护理质量。我们提供了一个表格以促进实施过程。
