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PERIOPERATIVE: Enhanced recovery after surgery

Enhanced recovery after surgery (ERAS) refers to redesigned perioperative care, sometimes also referred to as fast-track recovery after surgery.  Among the objectives are to reduce readmissions and avoid opioid abuse.  Changes include early ambulation, multi-modal analgesia and careful attention to nutrition.  The Cleveland Clinic includes ERAS in a list of the top 10 medical innovations for 2018.  The Gramlich article describes how the ERAS guidelines for colorectal surgery were implemented in six Canadian hospitals by the Alberta Health Services.  More information can also be obtained from the ERAS Society.

Sources:

Cleveland Clinic. Top 10 medical innovations.  Click here: http://innovations.clevelandclinic.org/Summit/Top-10-Medical-Innovations.aspx

Gramlich, L.M., and others. (2017). Implementation of enhanced recovery after surgery: A strategy to transform surgical care across a health system. Implementation Science. 12(67). Click here:  https://implementationscience.biomedcentral.com/track/pdf/10.1186/s13012-017-0597-5?site=implementationscience.biomedcentral.com

ERAS Society. Click here: http://erassociety.org/   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

VROOM! VROOM! Patient safety at 200 mph

Kuala Lumpur.  Shanghai.  Monte Carlo.  OR/ICU patient transfer.  Wait!  What do exotic locales have to do with handing off patients from the operating room to an intensive care unit?  Believe it or not, the common denominator is Formula One racing – more specifically, the Formula One pit crews who service the high-performance racing cars and their drivers with split-second timing precision during pit stops.  Two British physicians at the Great Ormand Street Hospital for Children (www.gosh.nhs.uk) in London were the first to draw an analogy between the timing and interaction of pit crews and the communication and hand-off protocols between surgery and ICU in their own facility.  After interviewing the head of the Ferrari pit crew, these two racing aficionados developed a patient transfer protocol that emphasized checklists and teamwork and resulted in measurable improvements.   The analogy was further amplified by subsequent research involving interviewing additional racing teams and focused on three key areas: preliminary staff training with briefings and checklists; active management and using technology to enhance communication; and post-transfer review of records to refine and reinforce the patient transfer protocol.  So whether at 200 miles per hour or 60 beats per second, safety relies on precision performance of each and every task.

Sources

Saver, Cynthia.  Handoffs: what ORs can learn from Formula One race crews.  OR Manager.  27(4):1, 11-13, April 2011.

Catchpole, Ken, and others.  Patient handovers within the hospital: translating knowledge from motor racing to healthcare.  Quality & Safety in Health Care.  19(4):318-322, August 2010.

Catchpole, Ken, and others.  Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality.  Paediatric Anaesthesia.  17(5):470-478, May 2007.     

For more on Formula 1 pit crews and pit stops, check out http://www.formula1.com/inside_f1/understanding_the_sport/5289.html and http://www.dummies.com/how-to/content/the-anatomy-of-a-formula-one-pit-stop.html.