A single page framework for enhanced recovery pathway implementation across the surgical specialties



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A SINGLE PAGE FRAMEWORK FOR ENHANCED RECOVERY PATHWAY IMPLEMENTATION ACROSS THE SURGICAL SPECIALTIES

Presenting Author: Michael Scott MB ChB12

Co-Authors: Paula Spencer MSHA, PMP, CPHIMS1, Mary Fain PMP1, Donna WiNborne BSN MHSA1, Alex Colquhoun MB ChB2, Ron Clark MD12

1RAM Care Quality Improvement Virginia Commonwealth University Health System, Richmond, VA 2Virginia Commonwealth Medical School, Richmond, VA

BACKGROUND

There are many barriers to implementation of Enhanced Recovery Pathways (ERPs). These include institutional barriers, financial silos, education and engagement of staff, and creation of a focused specialty enhanced recovery pathway.

Our RAM Care quality improvement team were tasked with implementing ERPs for every elective overnight stay and formulated a common one page implementation framework which has proved fundamental in simplifying the role out process and act as a quick reference tool for providers. We wish to share this to enable other health systems to benefit from this process.
METHODS

We initially developed a horizontal strategy to implement ERPs going specialty by specialty but realized many elements were common to all specialties. We then looked at a vertical implementation across all specialties breaking up the pathway into the following areas: preassessment and optimization, pre surgical unit, anesthesia and surgery in the operating room, post anesthetic care unit (PACU) and then postoperative care on the floor. Planned de-escalation of care


RESULTS

We developed a single page ERP for each specialty with common elements such as preoptimization for all specialties but also procedure specific elements and specific fluid and analgesia goals. The result is a compendium of ERPs for each specialty and procedure. We present 2 such frameworks in this abstract.




CONCLUSION

A single page framework guide helps in the role out of ERPs and also enables a concise summary of all surgical subspecialty procedures to be accessible as a guide to deliver care for all providers involved in the patient’s care.






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