How to implement an enhanced recovery program? Proposals from the Francophone Group for enhanced recovery after surgery (GRACE)

Slim, K.; Delaunay, Laurent; Joris, Jean; Diller, Leonard; Raspado, O.; Chambrier, C.; Ostermann, Sandrine; chirurgie, Le Groupe francophone de réhabilitation améliorée après

doi:10.1016/j.jviscsurg.2016.05.008

Cited by 23 publications

(6 citation statements)

References 11 publications

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“…In fact, we chose to start the implementation of ERP in our institution by a top-down approach which according to our survey, appears not clinically beneficial. In determinant factors involved in the ERP implementation, the multidisciplinary health care provider team mobilization and coordination is the corner stone for improvement (Slim et al 2016 ). In our approach, these teams were indirectly motivated by improvement measures proposed in 2016 at the APHP institutional level.…”

Section: Discussionmentioning

confidence: 99%

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Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

et al. 2021

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Background Enhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP). Methods A retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy and hysterectomy) in 17 hospitals including 29 surgical departments. Data were collected in one control intervention (total hip arthroplasty (THA), gastrectomy and ovariectomy). In 2016, Massive Open Online Course on ERP and a day meeting information were developed by APHP. A national update on ERP was also organized by HAS and a regional professional partnership programme was started. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients’ chart and in anaesthetist and surgeon interview. Seventy percent application rate reflects application of ERP procedure. Results 1321 patient’s files were analysed (812 in 2015 and 509 in 2017). The LOS (mean (SD)) is reduced by 1.6 day for TKA (2015, 8.7 (6.7) versus 7.1 (3.4) in 2017; p<0.001) but stable for colectomy and hysterectomy. Incidence of severe complications after surgery is unchanged in all types of surgical models. For TKA and hysterectomy respectively applied items of ERP (i.e. >70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. The mean application rates of ERP items stayed below 50% in all cases in 2017. The LOS was negatively correlated with ERP items’ application when data collected in 2015 and 2017 were analysed together. Conclusion ERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach.

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Section: Discussionmentioning

confidence: 99%

“…We did not have sufficient resources to provide this personalized approach on a large scale. Our general top-down initial approach did not offer these crucial levers and it should have been coordinated with local multidisciplinary team mobilization to support implementation success (Slim et al 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

et al. 2021

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“…In addition to the standard precautionary measures, ERP's goal is to use various medical and surgical techniques to minimize the addictive and dangerous effects of surgical intervention, permitting patients to recover early under optimal conditions. 12 More than an authored timeline is required to correctly adopt an ERP in daily practice. A structured organization and the involvement of multiple healthcare stakeholders are required for success.…”

Section: General Principlesmentioning

confidence: 99%

Early postoperative recovery quality assessment tools for day surgery patients

Nibaruta,

Xingjiao,

Xiaoxia

et al. 2023

Anaesth. pain intensive care

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From the patient's perspective, medical personnel must assess the patients’ recovery reliability in case of day surgery patients. Rather than focusing solely on clinical recovery indicators, it should consider the patient's pain, physiological, psychological, and social function, and quality of life, etc. Due to the return of day surgery patients to their homes following surgery, the doctors and the nurses require discrete observation and guidance. As a result, paying attention to the quality of recuperation following surgery of patients has critical clinical guiding significance. This guidance effectively pays attention to patient recovery, assists medical staff in taking some effective interventions for the quality of postoperative recovery of patients, and promotes high-quality nursing development. This review discusses the commonly used tools for postoperative evaluation in day surgery patients regarding pain assessment, quality of early postoperative recovery, and the quality of life. It examines some evaluation tools for their validity and application status in China and elsewhere. The clinical practice affects direct clinical personnel in evaluating the post-surgery quality of people undergoing daycare procedures. Keywords: Day surgery; Assessment tools; Pain; Postoperative recovery; Quality of life Citation: Nibaruta J, Xingjiao L, Xiaoxia H, Xiaoyu H, Xuefen C, Yufang L. Quality assessment tools for early postoperative recovery in day surgery patients. Anaesth. pain intensive care 2023;27(3):417−425; DOI: 10.35975/apic.v27i3.2201 Received: April 11, 2023; Reviewed: April 17, 2023; Accepted: May 12, 2023

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“…Eine Umsetzung von mehr als 70-75 % aller Fast-Track-Elemente bei allen Patienten ist ein realistisches Ziel der Implementierung und sollte so rasch wie möglich, spätestens aber nach 6 Monaten, erreicht werden. [10,49]. Möglichst viele Mitarbeiter aller Berufsgruppen müssen integriert werden, wobei fördernde und hemmende Faktoren gleichermaßen adressiert werden sollten [10].…”

Section: Klinische Implementierungunclassified

“…Möglichst viele Mitarbeiter aller Berufsgruppen müssen integriert werden, wobei fördernde und hemmende Faktoren gleichermaßen adressiert werden sollten [10]. Das beschriebene strukturelle Implementierungskonzept entspricht den Erkenntnissen der ERAS Society (https://erassociety.org) [14,16,17,19,52,53] und der französischsprachigen GRACE-Gruppe (Groupe francophone de Réhabilitation Améliorée après Chirurgie, https://www.grace-asso.fr/en) [49,54], die interessierten Kliniken strukturierte Implementie-rungsprogramme anbieten. Die von der ERAS Society gegründete schwedische Firma ENCARE (https://encare.net) führt die strukturierte Implementierung (ERAS Implementation Program -EIP, https://encare.net/eras-interactive-audit-system-eias/) durch, stellt ERAS-Protokolle verschiedener Operationen zur Verfügung [14,16,17,19,52,53] und bietet ein webbasiertes Datenbanksystem zur Dokumentation und Überprüfung der Fast-Track-Ergebnisse an (ERAS Interactive Audit System EIAS, https://encare.net/ the-eras-implementation-program-eip/).…”

Section: Klinische Implementierungunclassified

Strukturelle Implementierung eines Fast-Track-Programms – wie geht das?

2021

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ZusammenfassungFast-Track- oder ERAS-Konzepte gehen mit klinisch relevanten Vorteilen für operierte Patienten und ökonomischen Vorteilen für das Krankenhaus einher. Dennoch sind Fast-Track-Konzepte in Deutschland bislang nur in einzelnen chirurgischen Kliniken realisiert worden. Weder das Fehlen wissenschaftlicher Evidenz noch Einschränkungen durch das G-DRG-System sind Grund dieser ausbleibenden Fast-Track-Verbreitung in Deutschland. Vielmehr ist der Wandlungsprozess von der traditionellen perioperativen Behandlung zur evidenzbasierten Fast-Track-Therapie komplex und erfordert einen strukturierten und aufwendigen Implementierungsvorgang. International sind Programme zur Etablierung des Fast-Track etabliert und in zahlreichen Kliniken erfolgreich durchgeführt worden. Diese strukturierte Fast-Track-Implementierung wird in die Abschnitte organisatorische Vorbereitung, klinische Implementierung und Ergebnisüberprüfung gegliedert. Aufgrund der großen Komplexität der Wandlung ist eine externe Begleitung und Schulung des multiprofessionellen Teams durch externe Fast-Track-Spezialisten sinnvoll.

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How to implement an enhanced recovery program? Proposals from the Francophone Group for enhanced recovery after surgery (GRACE)

Cited by 23 publications

References 11 publications

Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

Early postoperative recovery quality assessment tools for day surgery patients

Strukturelle Implementierung eines Fast-Track-Programms – wie geht das?

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