Dyas Adam R, Kelleher Alyson D, Erickson Crystal J, Voss Jennifer A, Cumbler Ethan U, Lambert-Kerzner Anne, Vizena Annette S, Robinson-Chavez Celisse, Kee Brandi L, Barker Alison R, Fuller Melissa S, Miller Susan A, McCabe Katherine O, Cook Katharine M, Randhawa Simran K, Mitchell John D, Meguid Robert A
Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Surgery, University of Colorado School of Medicine. Anschutz Medical Campus. Aurora, CO, USA.
J Thorac Dis. 2022 Aug;14(8):2855-2863. doi: 10.21037/jtd-22-518.
Implementation of enhanced recovery after surgery (ERAS) pathways for patients undergoing anatomic lung resection have been reported at individual institutions. We hypothesized that an ERAS pathway can be successfully implemented across a large healthcare system including different types of hospital settings (academic, academic-affiliated, community).
An expert panel with representation from each hospital within a healthcare system was convened to establish a thoracic ERAS pathway for patients undergoing anatomic lung resection and to develop tools and analytics to ensure consistent application. The protocol was translated into an order set and pathway within the electronic health record (EHR). Iterative implementation was performed with recording of the processes involved. Barriers and facilitators to implementation were recorded.
Development and implementation of the protocol took 13 months from conception to rollout. Considerable change management was needed for consensus and incorporation into practice. Facilitators of change included peer accountability, incorporating ERAS care elements into the EHR, and conducting case reviews with timely feedback on protocol deviations. Barriers included institutional cultural differences, agreement in defining mindful deviation from the ERAS protocol, lack of access to specific coded data, and resource scarcity caused by the COVID-19 pandemic. Support from the hospital system's executive leadership and institutional commitment to quality improvement helped overcome barriers and maintain momentum.
Development and implementation of a health-system wide thoracic ERAS protocol for anatomic lung resections across a six-hospital health system requires a multidisciplinary team approach. Barriers can be overcome though multidisciplinary team engagement and executive leadership support.
已有个别机构报道了针对接受解剖性肺切除术患者的加速康复外科（ERAS）路径的实施情况。我们假设，ERAS路径能够在包括不同类型医院环境（学术型、学术附属医院型、社区型）的大型医疗系统中成功实施。
召集了一个由医疗系统内各医院代表组成的专家小组，为接受解剖性肺切除术的患者制定胸科ERAS路径，并开发工具和分析方法以确保其一致应用。该方案被转化为电子健康记录（EHR）中的医嘱集和路径。通过记录所涉及的过程进行迭代实施。记录实施过程中的障碍和促进因素。
从构思到推出，该方案的制定和实施耗时13个月。为达成共识并将其纳入实践，需要进行大量的变革管理。变革的促进因素包括同行问责制、将ERAS护理要素纳入EHR以及进行病例审查并及时反馈方案偏差。障碍包括机构文化差异、在定义与ERAS方案的合理偏差方面达成一致、无法获取特定编码数据以及由新冠疫情导致的资源短缺。医院系统行政领导的支持和机构对质量改进的承诺有助于克服障碍并保持推进势头。
在一个六家医院的医疗系统中，为解剖性肺切除术制定并实施全医疗系统范围的胸科ERAS方案需要采用多学科团队方法。通过多学科团队参与和行政领导支持可以克服障碍。
