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Implementation of an ERAS Program for Gynecological Oncology Surgery
Jordan Lewis & Dr. Kelly Mayson, Summer 2016
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Enhanced Recovery After Surgery (ERAS)
Surgical “fast-track” program Multimodal, evidence-based perioperative care pathway Success in Europe for 10+ years Validated to achieve early recovery after major surgeries Auditing compliance is key Aimed to achieve enhanced, better, and faster recovery through up to 21 pre-, intra-, and post-op components which each contribute to less complications and faster recovery Nothing new – started in the 1990s, used in a large European collaborative since early 2000, and many hospitals have began adopting ERAS for a variety of specialties ERAS protocol: has been implemented for specialties (i.e. general surgery, urology), but has yet to be implemented for gynecology oncology – this is the next phase Key Points: Active Patient Involvement 2) Involvement of the whole care team throughout the pt journey 3) Auditing the compliance & patient outcomes
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Summer Objectives: My Role
Pre- and Post- ERAS Implementation: Audit compliance for endometrial, ovarian & cervical cancer procedures Extract data from patient charts: real- time & retrospective Follow 30-day outcomes Assess patient satisfaction through follow-up phone call and questionnaire Recently, ERAS society has come out with official guidelines of gyne/onc to assess successful ERAS implementation and sustainability Patient-centered program* Data feeds back into improving Objective: successfully implement ERAS in gyn/onc (80% compliance)
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IMPLEMENTATION Late Aug-early Sept
Timeline IMPLEMENTATION Late Aug-early Sept >80% FUTURE DIRECTIONS: >80% compliance in all ERAS components (live feedback) 30-day outcomes on 100% ERAS cases Audit and compare pre- and post-ERAS outcomes UP UNTIL NOW: Ongoing education for all staff Develop ERAS documents Acquire NSQIP data CURRENTLY: Implement/audit intra-op by core group of anesthesiologists & surgeons (pre- and post: gradual upon approval) Acquire data & patient satisfaction from pre-ERAS cohorts Audit live ERAS charts Transition period Currently – gradual upon approval and distribution of ERAS documents & staff education
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Anticipated Results Reduction in symptoms delaying discharge, 30 day morbidity, and readmissions ↓ hypotension in PACU ↓ excessive pain ↓ PONV ↓ LOS N= 953 , * p < 0.05 Retrospective review of 953 cases from under going procedures for colorectal cancer. Include but not limited to… to ERAS protocol Gustafsson et al. Arch Surg 2011: 146(5)
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Thank you!
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