Aggregation of Marginal Gains in Cardiac Surgery: Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients

Fleming, Ian; Garratt, Claire; Guha, Ranj; Desai, Jatin; Chaubey, Sanjay; Wang, Yanzhong; Leonard, Sara; Kunst, Gudrun

doi:10.1053/j.jvca.2016.01.017

Cited by 131 publications

(102 citation statements)

References 18 publications

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“…Kalp ameliyatı dışı cerrahilerde uygulanan, ameliyat öncesinde başlayan ağrı oluşumunun değişik mekanizmalarını dikkate alarak ortaya konulan kombine ilaç uygulamalarının olumlu sonuçlar verdiği görülmektedir. Ağrı yönetimi hızlı taburcu programlarında gösterilen yararları ERAS programlarına da yansımıştır (5,15) . Hastalara yoğun bir ağrı tedavisi uygulanması ile erken ekstübasyon, mobilizasyon ve toparlanma süreci kolaylaşır.…”

Section: Ağrı Tedavisiunclassified

Evolution from Rapid Discharge Program to ERAS Protocols in Cardiovascular Surgery

Salihoğlu¹

2018

IKSST

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Kalp cerrahisindeki gelişmeler mortaliteyi azaltmakla beraber, komplikasyon ve maliyetleri azaltamamıştır. 1990'lı yıllarda başlatılan hızlı taburcu protokolleri yoğun bakım sürecini kısaltmasına rağmen, istenen düzeyde hastane kalış süresi ve morbiditeyi değiştirememiştir. Son yıllarda diğer cerrahi alanlarda oluşturulan ERAS porotokollerinin kalp cerrahisinde de uygulanmasına başlanmıştır. Bu çok yeni uygulamanın oluşturulmasındaki önemli noktalar ve bu konudaki tecrübeler bu derlemede ele alınarak irdelenmiştir.

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Section: Ağrı Tedavisiunclassified

Evolution from Rapid Discharge Program to ERAS Protocols in Cardiovascular Surgery

Salihoğlu¹

2018

IKSST

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“…Those seemingly irrelevant changes resulted in great success of his cyclists. The elimination of seemingly minor imperfections is likely to result in cumulative benefits, which should contribute to better treatment outcomes [35]. The success relies on teamwork involving care and management since the moment that indications for surgical treatment are recognised and patients qualified for surgery (the outpatient cardiology clinic) until the first post-operative follow-up in the above-mentioned clinic.…”

Section: Enhanced Recovery Aftermentioning

confidence: 99%

“…Fleming et al [35] published an analysis of a pilot group of patients who underwent surgical procedures for heart diseases carried out within the ERACS programme. The authors introduced a package of activities, which included the interventions mentioned in the present paper and additionally a single dose of oral gabapentin at a dose of 600 mg administered before surgery and lactulose in a daily dose of 15 mL from the first postoperative day until defecation.…”

Section: Enhanced Recovery Aftermentioning

confidence: 99%

It is time for enhanced recovery after surgery in cardiac surgery

Krzych

Kucewicz‐Czech²

2017

Kardiol Pol

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“…Our parallel review of AMG (Wood et al., ) shows that AMG is popular as a method of improving health care in areas such as surgery (Fleming et al., ), child and family health care (Lemer, Cheung, Klaber, & Hibbs, ), and mental health (Nierenberg, Hearing, Mathias, Young, & Sylvia, ). However, there is no literature describing AMG processes, no previously published AMG process model and it has not been used in nursing.…”

Section: Introductionmentioning

confidence: 99%

Amalgamation of Marginal Gains (AMG) as a potential system to deliver high‐quality fundamental nursing care: A qualitative analysis of interviews from high‐performance AMG sports and healthcare practitioners

Pentecost

Richards

Frost

2018

Journal of Clinical Nursing

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Aims and objectives:To investigate the components of the Amalgamation of Marginal Gains (AMG) performance system to identify a set of principles that can be built into an innovative fundamental nursing care protocol.Background: Nursing is urged to refocus on its fundamental care activities, but little evidence exists to guide practising nurses. Fundamental care is a combination of many small behaviours aimed at meeting a person's care needs. AMG is a successful system of performance management that focusses on small (or marginal) gains, and might provide a new delivery framework for fundamental nursing care.Design: Qualitative interview study. Methods:We undertook in-depth interviews with healthcare and sports professionals experienced in AMG. We analysed data using open coding in a framework analysis, and then interrogated the data using Normalisation Process Theory (NPT). We triangulated findings with AMG literature to develop an intervention logic model. Results:We interviewed 20 AMG practitioners. AMG processes were as follows:focusing on many details to optimise performance, identification of marginal gains using different sources, understanding current versus optimum performance, monitoring at micro and macro level and strong leadership. Elements of normalisation were as follows: whole team belief in AMG to improve performance, a collective desire for excellence using evidence-based actions, whole team engagement to identify choose and implement changes, and individual and group responsibility for monitoring performance. Conclusions:We have elicited the processes described by AMG innovators in health care and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice.Relevance to clinical practice: The development of our logic model based on AMG and NPT may provide a practical framework for improving fundamental nursing care and is ripe for further development and testing in clinical trials.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. In terms of building an evidence-base for essential nursing care, it is unlikely that focussing research on nursing activities to address just one aspect of care will be particularly helpful. Patients' care needs are complex, personalised and multifacetted. As a consequence, nursing has been described as the "quintessential complex intervention" • Small improvements can be made in all fundamental care areas that will impact on the best possible experience for patients.• AMG process has been mapped and the normalisation potential in practice identified.• The findings presented in a logic model of AMG in a Normalisation Process Theory framework will form the basis of our ESSENCE nursing intervention to improve the quality of nursing practice. nursing on delivering multiple yet small marginal gains for patients.The stu...

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Aggregation of Marginal Gains in Cardiac Surgery: Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients

Abstract: This pilot study demonstrated that ERACS is feasible and has the potential for improved postoperative morbidity after cardiac surgery. A larger multicenter quality improvement study implementing perioperative care bundles would be the next step to further assess outcomes in ERACS patients.

Cited by 131 publications

References 18 publications

Evolution from Rapid Discharge Program to ERAS Protocols in Cardiovascular Surgery

Evolution from Rapid Discharge Program to ERAS Protocols in Cardiovascular Surgery

It is time for enhanced recovery after surgery in cardiac surgery

Amalgamation of Marginal Gains (AMG) as a potential system to deliver high‐quality fundamental nursing care: A qualitative analysis of interviews from high‐performance AMG sports and healthcare practitioners

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