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TO LEARN MORE ABOUT ERAS, TALK WITH USAP ERAS EXPERTS DRS. R. HEATH GULDEN (DALLAS) AND MAURICIO MEJIA (DENVER), OR VISIT THE AMERICAN SOCIETY FOR ENHANCED RECOVERY AT WWW.ASERHQ.ORG.
STEPS FOR CREATING AN ERAS PROGRAM
• Identifyoneanesthesiachampionandonesurgeonchampionper surgery service line
• Engageadministrationtosetprogramguidelinesandexpectations
• Determinethenecessaryequipment(ECOM,EDM+,FloTrac, ultrasound, for nerve / TAP blocks, CADD, On-Q, dedicated nerve block areas, etc.)
• Notedrugexpensesandconsiderimplementingnarcotic-sparing strategies using analgesics (Exparel / Entereg / O rmev / Caldolor)
• Noteothernecessaryresourcesinpersonnelanddataanalysis
• Developpilotprotocols
• Educatesta onERASprotocols
• ElectanERASCoordinator
• FormamultidisciplinaryERASCommittee
• Determinewhichdatatoanalyzeinyourpilotprotocolsandre ne the quality initiative process
• CreateanERAScheatsheetforsta tosimplifytheprocess
• Createinformationalhandoutsforpatients
• Reevaluateprogramprogressperiodicallyandimproveormodify as necessary ■
Interested in bringing ERAS to your facility? Here’s a list of available ERAS guidelines, those in development and the planned gridline extension:
EXISTING ERAS GUIDELINES:
Pancreaticoduodenectomy (Whipple) Elective colonic surgery
Rectal / pelvic surgery (APR) Radical cystectomy for bladder cancer Gastrectomy
ERAS GUIDELINES IN DEVELOPMENT:
Liver resection Total knee replacement Total hip replacement Obesity surgery Nephrectomy Major gynecological
ERAS FUTURE PIPELINE :
ENT surgery
Breast reconstruction Non-cardiac thoracic surgery Esophageal resections
Sources:
1. Liane S. Feldman, Conor P. Delaney, Olle Ljungqvist and Francesco Carli (eds.) The SAGES /
ERAS ® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery
2. TheSAGES/ERAS®SocietyManualofEnhancedRecoveryProgramsforGastrointestinal
Surgery. Springer International Publishing. Kindle Edition. SAMBA (www.sages.org)
3. WallStreetJournal,March31,2015,LauraLandro“PatientsBounceBackFasterfromSurgerywith
Hospitals’ New Protocol”
4. www.encare.se
5. ERASSociety(www.erassociety.org)
6. TheSAGES/ERASSocietyManualofEnhancedRecoveryProgramsforGastrointes1nalSurgery.
Feldman, et al. Springer. 2015 (Amazon)
OR SAFETY | FROM PAGE 33
Dr. Calder notes that as surgical teams become familiar with each other throughout the course of the day, months, years, the formality of introducing names and roles may seem unnecessary or redundant; but, she says, it’s still a vital part of the process and becomes most important when equipment reps, students, fellows and others are present for a surgery. Going through each step of the checklist and giving each question its due
is important for high-quality patient care. Each case is a person. And each person deserves our best. The checklist helps us achieve this optimal care with each case throughout the day, day in and day out.
ANESTHESIA TIME OUT
Patient name
Date of birth
Procedure
Surgeon
Allergies
Aspiration risk
Potential di cult airway Lines
Need for blood and availability SCDSs (to prevent bloodclots) Suction
Special monitoring
Plan for normothermia
Sources:
1. http://www.hhnmag.com/articles/6184-patient-safety-in-the-or
2. https://www.jointcommission.org/
3. http://www.hpoe.org/Reports-HPOE/CkLists_PatientSafety.pdf
4. http://apps.who.int/iris/bitstream/10665/44186/2/9789241598590_eng_
Checklist.pdf
5. https://www.hsph.harvard.edu/news/press-releases/checklists-in-operating-rooms-
improve-performance-during-crises/
6. http://www.safesurgery2015.org/
7. https://thenextregeneration.wordpress.com/2014/04/16/new-study-shows-
surgical-checklists-in-operating-rooms-are-less-e ective-than-assumed/
8. http://www.who.int/patientsafety/safesurgery/checklist/en/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489073/
10. http://www.safesurgery2015.org/checklist-templates.html
11. http://apps.who.int/iris/bitstream/10665/44186/2/9789241598590_eng_
Checklist.pdf
12. http://intqhc.oxfordjournals.org/content/25/2/182
13. https://www.ncbi.nlm.nih.gov/pubmed/23335056
ISSUE ONE | CONNECTED
