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Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system

BACKGROUND: Implementation of enhanced recovery after surgery (ERAS) pathways for patients undergoing anatomic lung resection have been reported at individual institutions. We hypothesized that an ERAS pathway can be successfully implemented across a large healthcare system including different types...

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Autores principales: Dyas, Adam R., Kelleher, Alyson D., Erickson, Crystal J., Voss, Jennifer A., Cumbler, Ethan U., Lambert-Kerzner, Anne, Vizena, Annette S., Robinson-Chavez, Celisse, Kee, Brandi L., Barker, Alison R., Fuller, Melissa S., Miller, Susan A., McCabe, Katherine O., Cook, Katharine M., Randhawa, Simran K., Mitchell, John D., Meguid, Robert A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9442517/
https://www.ncbi.nlm.nih.gov/pubmed/36071784
http://dx.doi.org/10.21037/jtd-22-518
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author Dyas, Adam R.
Kelleher, Alyson D.
Erickson, Crystal J.
Voss, Jennifer A.
Cumbler, Ethan U.
Lambert-Kerzner, Anne
Vizena, Annette S.
Robinson-Chavez, Celisse
Kee, Brandi L.
Barker, Alison R.
Fuller, Melissa S.
Miller, Susan A.
McCabe, Katherine O.
Cook, Katharine M.
Randhawa, Simran K.
Mitchell, John D.
Meguid, Robert A.
author_facet Dyas, Adam R.
Kelleher, Alyson D.
Erickson, Crystal J.
Voss, Jennifer A.
Cumbler, Ethan U.
Lambert-Kerzner, Anne
Vizena, Annette S.
Robinson-Chavez, Celisse
Kee, Brandi L.
Barker, Alison R.
Fuller, Melissa S.
Miller, Susan A.
McCabe, Katherine O.
Cook, Katharine M.
Randhawa, Simran K.
Mitchell, John D.
Meguid, Robert A.
author_sort Dyas, Adam R.
collection PubMed
description BACKGROUND: Implementation of enhanced recovery after surgery (ERAS) pathways for patients undergoing anatomic lung resection have been reported at individual institutions. We hypothesized that an ERAS pathway can be successfully implemented across a large healthcare system including different types of hospital settings (academic, academic-affiliated, community). METHODS: An expert panel with representation from each hospital within a healthcare system was convened to establish a thoracic ERAS pathway for patients undergoing anatomic lung resection and to develop tools and analytics to ensure consistent application. The protocol was translated into an order set and pathway within the electronic health record (EHR). Iterative implementation was performed with recording of the processes involved. Barriers and facilitators to implementation were recorded. RESULTS: Development and implementation of the protocol took 13 months from conception to rollout. Considerable change management was needed for consensus and incorporation into practice. Facilitators of change included peer accountability, incorporating ERAS care elements into the EHR, and conducting case reviews with timely feedback on protocol deviations. Barriers included institutional cultural differences, agreement in defining mindful deviation from the ERAS protocol, lack of access to specific coded data, and resource scarcity caused by the COVID-19 pandemic. Support from the hospital system’s executive leadership and institutional commitment to quality improvement helped overcome barriers and maintain momentum. CONCLUSIONS: Development and implementation of a health-system wide thoracic ERAS protocol for anatomic lung resections across a six-hospital health system requires a multidisciplinary team approach. Barriers can be overcome though multidisciplinary team engagement and executive leadership support.
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spelling pubmed-94425172022-09-06 Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system Dyas, Adam R. Kelleher, Alyson D. Erickson, Crystal J. Voss, Jennifer A. Cumbler, Ethan U. Lambert-Kerzner, Anne Vizena, Annette S. Robinson-Chavez, Celisse Kee, Brandi L. Barker, Alison R. Fuller, Melissa S. Miller, Susan A. McCabe, Katherine O. Cook, Katharine M. Randhawa, Simran K. Mitchell, John D. Meguid, Robert A. J Thorac Dis Original Article BACKGROUND: Implementation of enhanced recovery after surgery (ERAS) pathways for patients undergoing anatomic lung resection have been reported at individual institutions. We hypothesized that an ERAS pathway can be successfully implemented across a large healthcare system including different types of hospital settings (academic, academic-affiliated, community). METHODS: An expert panel with representation from each hospital within a healthcare system was convened to establish a thoracic ERAS pathway for patients undergoing anatomic lung resection and to develop tools and analytics to ensure consistent application. The protocol was translated into an order set and pathway within the electronic health record (EHR). Iterative implementation was performed with recording of the processes involved. Barriers and facilitators to implementation were recorded. RESULTS: Development and implementation of the protocol took 13 months from conception to rollout. Considerable change management was needed for consensus and incorporation into practice. Facilitators of change included peer accountability, incorporating ERAS care elements into the EHR, and conducting case reviews with timely feedback on protocol deviations. Barriers included institutional cultural differences, agreement in defining mindful deviation from the ERAS protocol, lack of access to specific coded data, and resource scarcity caused by the COVID-19 pandemic. Support from the hospital system’s executive leadership and institutional commitment to quality improvement helped overcome barriers and maintain momentum. CONCLUSIONS: Development and implementation of a health-system wide thoracic ERAS protocol for anatomic lung resections across a six-hospital health system requires a multidisciplinary team approach. Barriers can be overcome though multidisciplinary team engagement and executive leadership support. AME Publishing Company 2022-08 /pmc/articles/PMC9442517/ /pubmed/36071784 http://dx.doi.org/10.21037/jtd-22-518 Text en 2022 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Dyas, Adam R.
Kelleher, Alyson D.
Erickson, Crystal J.
Voss, Jennifer A.
Cumbler, Ethan U.
Lambert-Kerzner, Anne
Vizena, Annette S.
Robinson-Chavez, Celisse
Kee, Brandi L.
Barker, Alison R.
Fuller, Melissa S.
Miller, Susan A.
McCabe, Katherine O.
Cook, Katharine M.
Randhawa, Simran K.
Mitchell, John D.
Meguid, Robert A.
Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system
title Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system
title_full Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system
title_fullStr Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system
title_full_unstemmed Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system
title_short Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system
title_sort development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9442517/
https://www.ncbi.nlm.nih.gov/pubmed/36071784
http://dx.doi.org/10.21037/jtd-22-518
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