Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado, Aurora, Colorado; Department of Surgery, University of Colorado Hospital, Aurora, Colorado.
Department of Surgery, University of Colorado Hospital, Aurora, Colorado.
J Surg Res. 2024 Jan;293:144-151. doi: 10.1016/j.jss.2023.08.022. Epub 2023 Sep 27.
Compliance with thoracic Enhanced Recovery After Surgery (ERAS) protocols is critical to achieving their maximum benefits. We sought to examine utilization of quality review meetings as a method to improve protocol compliance through identification and resolution of barriers with compliance.
A multidisciplinary committee implemented a thoracic ERAS protocol for anatomic lung resections across five hospitals within our health system. Compliance data at one institution were tracked for 4 mo after initiation of the ERAS protocol; a quality review meeting was held at one hospital, and two additional months of compliance data were recorded. Outcomes of interest were compliance changes to five protocol elements. Pathway elements deferred due to "mindful deviation" were excluded. Chi-square and Fisher's exact tests were used to compare compliance differences.
We included 81 patients: 53 patients before the quality review meeting and 28 after. There were 405 compliance opportunities; 68 (17%) were excluded for mindful deviation, leaving 337 (83%) for inclusion. Overall compliance improved from 53% before to 84% after the quality review meeting. Compliance to avoiding intraoperative urinary catheters, placing chest tubes to water seal in postanesthesia care unit, liberal chest tube removal, and postoperative multimodal pain regimen use improved after the quality review meeting (P values <0.05). Use of preoperative pain bundles was not significantly different (87% versus 96%, P = 0.25).
Conducting a quality review meeting significantly improved ERAS protocol element use at our intervention healthcare region. This methodology should be considered at other institutions implementing surgical protocols.
遵守胸外科增强型术后恢复（ERAS）方案对于实现其最大效益至关重要。我们试图通过识别和解决与合规性相关的障碍，研究利用质量审查会议来提高方案合规性。
一个多学科委员会在我们的医疗系统内的五家医院实施了胸外科 ERAS 方案。在 ERAS 方案启动后，一家机构的合规数据被跟踪了 4 个月；在一家医院举行了质量审查会议，并记录了另外两个月的合规数据。感兴趣的结果是对五个方案要素的合规性变化。由于“谨慎偏离”而推迟的途径要素被排除在外。使用卡方检验和 Fisher 确切检验比较合规性差异。
我们纳入了 81 例患者：质量审查会前有 53 例，会后有 28 例。共有 405 次合规机会；由于谨慎偏离，有 68 次（17%）被排除，剩下 337 次（83%）纳入。总体合规性从质量审查会前的 53%提高到了 84%。质量审查会后，避免术中导尿管、在麻醉后护理单元将胸腔引流管置于水封、宽松地移除胸腔引流管以及术后多模式疼痛方案的使用得到了改善（P 值均<0.05）。术前疼痛包的使用没有显著差异（87%与 96%，P=0.25）。
在我们干预的医疗区域，进行质量审查会议显著提高了 ERAS 方案要素的使用。这种方法应在其他实施手术方案的机构中考虑。
