References

Azawi NH, Christensen T, Petri AL, Kehlet H. Prolonged length of hospital stay in Denmark after nephrectomy. Dan Med J. 2012; 59:(6)

Balfour A, Burch J, Fecher-Jones I, Carter FJ. Understanding the benefits and implications of enhanced recovery after surgery. Nurs Stand. 2019; 34:(7)70-75 https://doi.org/10.7748/ns.2019.e11437

Bernard H, Foss M. Patient experiences of enhanced recovery after surgery (ERAS). Br J Nurs. 2014; 23:(2)100-106 https://doi.org/10.12968/bjon.2014.23.2.100

Bonde CT, Khorasani H, Elberg J, Kehlet H. Perioperative optimization of autologous breast reconstruction. Plast Reconstr Surg. 2016; 137:(2)411-414 https://doi.org/10.1097/01.prs.0000475749.40838.85

Duriaud HM, Kroman N, Kehlet H. Feasibility and safety of outpatient breast cancer surgery. Dan Med J. 2018; 65:(3)

Francis NK, Walker T, Carter F Consensus on training and implementation of enhanced recovery after surgery: a Delphi study. World J Surg. 2018; 42:(7)1919-1928 https://doi.org/10.1007/s00268-017-4436-2

Gillissen F, Ament SMC, Maessen JMC Sustainability of an enhanced recovery after surgery program (ERAS) in colonic surgery. World J Surg. 2015; 39:(2)526-533 https://doi.org/10.1007/s00268-014-2744-3

Hakkennes S, Dodd K. Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care. 2008; 17:(4)296-300 https://doi.org/10.1136/qshc.2007.023804

Hjort Jakobsen DH, Rud K, Kehlet H, Egerod I. Standardising fast-track surgical nursing care in Denmark. Br J Nurs. 2014; 23:(9)471-476 https://doi.org/10.12968/bjon.2014.23.9.471

Hu QL, Liu JY, Hobson DB Best practice in data use for achieving successful implementation of enhanced recovery pathway. J Am Coll Surg. 2019; 229:(6)626-632.e1 https://doi.org/10.1016/j.jamcollsurg.2019.08.1448

Hunter B, Segrott J. Re-mapping client journeys and professional identities: A review of the literature on clinical pathways. Int J Nurs Stud. 2008; 45:(4)608-625 https://doi.org/10.1016/j.ijnurstu.2007.04.001

Ivers N, Jamtvedt G, Flottorp S Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012; (6) https://doi.org/10.1002/14651858.CD000259.pub3

Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997; 78:(5)606-617 https://doi.org/10.1093/bja/78.5.606

Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008; 248:(2)189-198 https://doi.org/10.1097/SLA.0b013e31817f2c1a

Kehlet H. Fast-track colonic surgery and the ‘knowing–doing’ gap. Nat Rev Gastroenterol Hepatol. 2011; 8:(10)539-540 https://doi.org/10.1038/nrgastro.2011.153

Kehlet H, Harling H. Length of stay after laparoscopic colonic surgery - an 11-year nationwide Danish survey. Colorectal Dis. 2012; 14:(9)1118-1120 https://doi.org/10.1111/j.1463-1318.2011.02922.x

Kehlet H, Jørgensen CC. Advancing surgical outcomes research and quality improvement within an enhanced recovery program framework. Ann Surg. 2016; 264:(2)237-238 https://doi.org/10.1097/SLA.0000000000001674

Kehlet H. ERAS Implementation—time to move forward. Ann Surg. 2018; 267:(6)998-999 https://doi.org/10.1097/SLA.0000000000002720

Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery. JAMA Surg. 2017; 152:(3)292-298 https://doi.org/10.1001/jamasurg.2016.4952

Maessen J, Dejong CHC, Hausel J A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg. 2007; 94:(2)224-231 https://doi.org/10.1002/bjs.5468

Mertz BG, Kroman N, Williams H, Kehlet H. Fast-track surgery for breast cancer is possible. Dan Med J. 2013; 60:(5)

Modesitt SC, Sarosiek BM, Trowbridge ER Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization. Obstet Gynecol. 2016; 128:(3)457-466 https://doi.org/10.1097/AOG.0000000000001555

Petersen PB, Jørgensen CC, Kehlet H Temporal trends in length of stay and readmissions after fast-track hip and knee arthroplasty. Dan Med J. 2019; 66:(7)

Rønfeldt LL, Hjort Jakobsen D, Kehlet H, Lipczak H, Wennervaldt K. Quality of surgical guidelines and written patient information. A nationwide patient safety study. Dan Med J. 2018; 65:(6)

Specht K, Kjaersgaard-Andersen P, Kehlet H, Pedersen BD. Nursing in fast-track total hip and knee arthroplasty: a retrospective study. Int J Orthop Trauma Nurs. 2015; 19:(3)121-130 https://doi.org/10.1016/j.ijotn.2014.10.001

A simple method to secure data-driven improvement of perioperative care

14 May 2020
9 min read
Volume 29 · Issue 9

Abstract

Background:

Enhanced recovery after surgery (ERAS) programmes have been adopted to a varying degree by most surgical departments, not only in Denmark, but worldwide.

Aims:

To report the process from a local ERAS unit in a tertiary university hospital to accelerate implementation of ERAS programmes in all surgical specialties.

Methods:

All surgical departments receive twice-yearly procedure-specific data on length of stay (LOS), readmission rates and death within 30 days, based on surgical codes and the Danish National Patient Register. The ERAS unit and clinical experts review data followed by a clinical audit where appropriate.

Findings:

Setting up data presentation for clinical and nurse leaders has documented progress in implementing ERAS. The combination of outcome data, together with audits have been essential.

Conclusion:

The local ERAS unit has been shown to accelerate implementation of ERAS programmes in all surgical specialties, facilitated by procedure-specific LOS and re-admission data, combined with audit data.

Enhanced recovery after surgery (ERAS) programmes aim to achieve early recovery after surgery. The concept focuses on optimising all the important perioperative components, such as optimised patient information, anaesthesia, pain and fluid therapy and minimally invasive surgery, together with updated care principles, such as the use of drains, catheters, fasting rules, early mobilisation and nutrition (Kehlet and Wilmore, 2008). ERAS is a multidisciplinary concept in which nursing has a major and decisive impact, as the quality of perioperative care is essential to improve the postoperative outcome. Thus, it is crucial that nurses understand their role and the background and impact of ERAS programmes (Balfour et al, 2019).

Enhanced recovery programmes have been described in all surgical specialties based on procedure-specific, evidence-based clinical guidelines, showing benefits such as faster recovery and reduced length of stay, without increased risk of readmission, fewer medical complications (cardiovascular, pulmonary and thromboembolic), less fatigue and faster resumption of normal daily activities after discharge, as well as reduced costs (Kehlet and Jørgensen, 2016; Ljungqvist et al, 2017).

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