Overcoming common obstacles to implementing a perioperative surgical home
Over the last 5 years, the perioperative surgical home (PSH) model has attracted increasing interest from OR directors, anesthesiologists, and surgeons. This team-based, patient-centered approach coordinates all phases of surgical care, from preoperative assessment through intraoperative care and postdischarge recovery. According to the American Society of Anesthesiologists, PSH initiatives have…
Establishing and leveraging data analytics for ERAS
Virginia Commonwealth University Health System (VCU Health) in Richmond is a Magnet facility, and as such we continually examine innovative ideas to improve the quality, safety, and care of our patients. Evidence has linked Enhanced Recovery After Surgery (ERAS) with better outcomes, and ERAS has become a focal point at…
Outcomes, costs of Medicare patients having surgery at teaching vs nonteaching hospitals
Editor's Note This study of Medicare patients at 340 teaching hospitals and matched patient controls at 2,444 nonteaching hospitals found that as risk of mortality increased, the mortality benefit of treatment at teaching hospitals also increased, though with marginally higher costs. Included in the analysis were 86,751 pairs of general,…
Surgeons reduce opioid prescriptions using new multipronged strategy
Editor's Note A system-wide, multipronged pain management and opioid reduction program significantly reduced postoperative opioid discharge prescriptions written for more than 5 days, this study finds. Surgeon education, monitoring, and incentives lead to a shift from longer-term to shorter-term prescriptions for patients after surgery, reducing postoperative opioid prescriptions of more…
Back to basics: How collaboration can improve PACU patient flow
Healthcare technology can be a great thing, but nurses at Abington—Jefferson Health, in Abington, Pennsylvania, have discovered that sometimes stepping back from it is the best way to make progress. Going low-tech was the key that unlocked patient flow gridlock that had plagued the postanesthesia care unit (PACU). Before 2017,…
Using project management principles to hardwire ERAS protocols
Implementation of Enhanced Recovery After Surgery (ERAS) at Virginia Commonwealth University (VCU) Health System in Richmond has been achieved through project and change management tools that transform the current state to the desired future state. To hardwire ERAS protocols in the OR as well as the ambulatory and acute care…
Using smartphones to capture patient differences in postop physical recovery
Editor's Note Metrics derived from smartphone accelerometer data can capture differences in postoperative physical recovery in surgical patients, this study finds. In this analysis of 62 patients, smartphone accelerometer data showed decreases in daily exertional activity in 17 who experienced a postoperative event (eg, complication, reoperation) up to 6 weeks…
Association of geriatric-specific characteristics with postop readmissions
Editor's Note In this study from the University of Virginia, new geriatric-specific characteristics were found to raise the risk of elderly surgical patients having unplanned readmissions within a month of leaving the hospital. The four geriatric-specific risk factors for readmission include: cognitive impairment requiring another person to sign the patient’s…
Association between ERAS and postop complications after total hips and knees
Editor's Note Increased adherence to an Enhanced Recovery After Surgery (ERAS) protocol after total hip arthroplasty (THA) and total knee arthroplasty (TKA) was associated with a decrease in postoperative complications in this study from Spain. However, only a few interventions were linked to decreased complications In this analysis of 6,146…
Standardized pathway for outpatient ambulatory fracture surgery
Editor's Note In this study, an outpatient fracture pathway greatly improved the efficiency and timeliness of care, and it reduced costs. A total of 187 patients during the preintervention period and 308 patients during the intervention period were eligible for the ambulatory pathway. Those managed as outpatients increased from 1.6%…
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