Improving surgical wound classification accuracy through education and audit processes.

Precise wound classification is essential for surgical site infection risk stratification and appropriate hospital reimbursement. We instituted a multifaceted approach to improve institutional wound class identification including an education and awareness bundle, as well as a formal audit process. Overall, we saw significant improvements in wound class accuracy, interprofessional collaboration and provider compliance.

Impact of an Enhanced Recovery After Surgery Protocol on Unplanned Patient Encounters in the Early Postoperative Period After Ureteroscopy.

Introduction: Ureteroscopy (URS) is associated with substantial patient-perceived morbidity. To improve the patient experience, we developed an enhanced recovery after surgery (ERAS) protocol for URS. We sought to determine if an ERAS protocol could reduce unplanned patient-initiated encounters. Materials and Methods: The ERAS protocol involves the preoperative administration of four medications to patients undergoing URS. We reviewed data on 100 consecutive patients undergoing URS with ureteral stent placement between April 2018 and August 2018. All unplanned postoperative encounters, including phone calls and electronic medical record messages, unplanned urology outpatient visits, emergency department (ED) visits, and re-admissions within 30 days of surgery, were recorded. A control group of patients undergoing URS between July 2013 and November 2014 served as a comparison group. Propensity score matching was performed. Statistical analysis included Mann-Whitney U test, Student's t-test, and Fischer's exact test. Univariable and multivariable (MVA) analyses were performed. Results: Using propensity score matching, 71 pre-ERAS (median age 57 years, interquartile range [IQR] 44-65) and 71 post-ERAS (median age 56 years, IQR 47-68) patients were compared. Although ED visits and postoperative readmissions were comparable between the two groups, significantly more unplanned phone calls/messages occurred in the pre-ERAS group than in the post-ERAS group (71 vs 27, respectively, p < 0.001). MVA regression analysis identified the ERAS protocol as a significant independent predictor of fewer patient calls (odds ratio 0.24, 95% confidence interval 0.12-0.50, p < 0.001). Conclusions: Analysis of an ERAS protocol for patients undergoing URS showed a reduction in unplanned patient-initiated communication, with implementation of the protocol. ClinicalTrials.gov: NCT04112160.

The impact of implementation of a hysterectomy enhanced recovery pathway on anesthetic medication costs.

Aim: To evaluate the effect of implementation of a hysterectomy Enhanced Recovery After Surgery (ERAS) protocol on perioperative anesthetic medication costs. Patients & methods: Historical cohort study of 84 adult patients who underwent a hysterectomy. Forty-two patients who underwent surgery before protocol implementation comprised the pre-ERAS group. Forty-two patients who underwent surgery after protocol implementation comprised the post-ERAS group. Data on anesthetic medication costs and outcomes were analyzed. Results: Compared with the pre-ERAS group, the post-ERAS group's total medication cost was significantly lower (median: 325.20 USD; interquartile range [IQR]: 256.12-430.65 USD vs median: 273.10 USD; IQR: 220.63-370.59 USD, median difference: -40.76, 95% CI: -130.39, 16.99, p = 0.047). Length of stay was significantly longer in pre-ERAS when compared with post-ERAS groups (median: 5.0 days; IQR: 4.0-7.0 days vs median: 3.0 days; IQR: 3.0-4.0 days, median difference: -2.0 days, 95% CI: -2.5581, -1.4419, p < 0.0001). Conclusion: ERAS protocols may reduce perioperative medication costs.

Two unique studies highlighting the positive effects of enhanced recovery after surgery (ERAS) pathways on patient care and satisfaction / Dos estudios únicos en los que se destacan los efectos positivos de los protocolos ERAS (Recuperación rápida después de cirugía) para la atención y la satisfacción de los pacientes

Enhanced recovery after surgery (ERAS) programs are clinical pathways designed to "fast-track" patients back to baseline health as quickly as possible after surgery. These perioperative plans were initially conceived by Kehlet1,a surgeon in Europe. Kehlet and Mogensen2 designed surgical interventions to improve patient outcomes in colorectal surgery. The central tenets of ERAS pathways include: minimal fasting time/early satiety, early ambulation, and multimodal analgesia.3 By employing these concepts, they were able to significantly decrease their surgical patient's length of stay without increasing complications.2 Since that time, ERAS programs have expanded to many countries and across other surgical subspecialties with similar results. Other interventions such as pre-operative surgical and anesthetic education, pre-habilitation, optimization of chronic medical conditions, minimizing bowel preparation/fasting times, carbohydrate loading, multimodal analgesia, nausea and vomiting prophylaxis, thromboembolism prophylaxis, standard antibiotics, standardized operative ventilation strategies, goal-directed fluid therapy, early postoperative ingestion of clear fluids, and early ambulation have been incorporated into various ERAS pathways.4 Typical goals of these programs include decreased length of stay, decreased morbidity and mortality, and improved patient secondary outcomes.5 By reducing hospital stay and complications, hospital systems, and patients experience decreased overall costs. 6 In this editorial, I will comment on 2 articles using ERAS pathways to show positive effects on patient care and satisfaction.

Los programas de recuperación mejorada después de la cirugía (ERAS) son vías clínicas diseñadas para "acelerar" a los pacientes para que vuelvan a su estado de salud inicial lo más rápido posible después de la cirugía. Estos planes perioperatorios fueron concebidos inicialmente por Kehlet1, un cirujano en Europa. Kehlet y Mogensen2 diseñaron intervenciones quirúrgicas para mejorar los resultados de los pacientes en cirugía colorrectal. Los principios centrales de las vías ERAS incluyen: tiempo mínimo de ayuno / saciedad temprana, deambulación temprana y analgesia multimodal.3 Al emplear estos conceptos, pudieron disminuir significativamente la duración de la estadía del paciente quirúrgico sin aumentar las complicaciones.2 Desde entonces, ERAS Los programas se han expandido a muchos países y a otras subespecialidades quirúrgicas con resultados similares. Otras intervenciones tales como educación preoperatoria quirúrgica y anestésica, pre-habilitación, optimización de condiciones médicas crónicas, minimización de los tiempos de preparación / ayuno intestinal, carga de carbohidratos, analgesia multimodal, profilaxis de náuseas y vómitos, profilaxis de tromboembolismo, antibióticos estándar, estrategias de ventilación operativa estandarizadas , la fluidoterapia dirigida por objetivos, la ingestión posoperatoria temprana de líquidos claros y la deambulación temprana se han incorporado en varias vías del ERAS.4 Los objetivos típicos de estos programas incluyen la disminución de la duración de la estadía, la disminución de la morbilidad y la mortalidad y la mejora de los resultados secundarios del paciente.5 reducir la estancia hospitalaria y las complicaciones, los sistemas hospitalarios y los pacientes experimentan una reducción de los costos generales. 6 En este editorial, comentaré 2 artículos que utilizan las vías ERAS para mostrar efectos positivos en la atención y satisfacción del paciente.