OR Manager - June 2020 - 21

Special Series: ERAS
SPECIAL SERIES
comes of surgery-the goal must be
to implement all 24 elements. (Many
of these elements are described in
" Enhanced Recovery After Surgery:
The new standard for perioperative
care, " OR Manager, October 2019, 1,
14-17.)
At VCU Health, our approach has
been to implement these elements
across surgical specialties as standard
work. We have introduced variation
by specialty only where that has
been clinically indicated. This approach
requires the engagement of
every surgeon, anesthesiologist, and
nurse who works in perioperative services,
the outpatient clinics, and the
inpatient units where surgery patients
recover.
It is challenging to introduce simultaneously
a large number of new interventions
among providers of differing
specialties and across multiple geographic
areas of the hospital. Even implementing
24 core elements one specialty
at a time can be complex. When
determining your approach, consider
the degree of difference between your
current and future state, how much
disruption the transition will cause,
and the resources you have to support
the change.
Use meaningful data to
engage stakeholders
High accountability and resiliency
are characteristics needed to move
large projects through change even if
the change is one that is readily accepted
or " is the right thing to do. "
The best way to engage medical professionals
in change is through the
use of meaningful data. (Examples
of such data were given in " Establishing
and leveraging data analytics
for ERAS, " OR Manager, April 2020,
22-23.)
Measures of comparison must be
utilized as " vital signs " to help healthcare
leaders understand recent performance
and where improvement is
www.ormanager.com
High accountability and resiliency
are needed to move large projects
through change.
needed. In addition, the data must be
valid and transparent as possible to
ensure the team(s) have confidence in
the protocols.
By aligning these system goals
with the professional ethics of providers,
we shift the focus from improving
comparative measures toward
improving patient outcomes.
Identification, planning, and implementation
of a systemwide ERAS
program is a journey encompassing
passion, strategy, leadership, governance,
and data. Leaders and stakeholders
need the determination, resiliency,
and patience to guide and
sustain process changes. ✥
Susan Torti, MBA, RN, is
vice president of perioperative/procedural
and
sterile processing services
at Virginia Commonwealth
University Health
System in Richmond.
Robin Hemphill, MD,
MPH, is vice president
of quality and safety at
Virginia Commonwealth
University Health System
as well as associate
dean of quality,
safety, and service at the VCU School of
Medicine in Richmond.
Wilhelm Zuelzer, MD, is
chief of perioperative
services operations and
professor and vice
chair, department of orthopaedics
at Virginia
Commonwealth University
Health System in Richmond.
Paula Spencer, MSHA,
PMP, CPHIMS, is director,
office of clinical effectiveness,
at Virginia
Commonwealth University
Health System in
Richmond.
References
1. https://www.prosci.com/resources/
articles/seven-change-concepts.
2. Martin D, Roulin D, Grass F, et al. A
multicentre qualitative study assessing
implementation of an Enhanced
Recovery After Surgery program. Clin
Nutr. 2018;37:2172-2177.
3. Pearsall E A, Meghji Z, Pitzul K B, et
al. A qualitative study to understand
the barriers and enablers in implementing
an Enhanced Recovery
After Surgery program. Ann Surg.
2014;261(1):92-96.
4. Burwell S M. Setting value-based
payment goals-HHS efforts to improve
US health care. N Engl J Med.
2018;372(10):897-899.
Resources
Bond-Smith G, Belgaumkar A P, Davidson
B R, et al. Enhanced recovery
protocols for major upper gastrointestinal,
liver and pancreatic surgery.
Cochrane Database Syst Rev.
2016;2:Cd011382.
Cerantola Y, Valerio M, Persson B,
et al. Guidelines for perioperative
care after radical cystectomy for
bladder cancer: Enhanced Recovery
After Surgery (ERAS(®) society
recommendations. Clin Nutr.
2013;32(6):879-887.
Greco M, Capretti G, Beretta L, et
al. Enhanced recovery program in
colorectal surgery: A meta-analysis
of randomized controlled trials.
World J Surg. 2014;38(6):1531e41.
OR Manager | June 2020
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OR Manager - June 2020

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