Enhanced recovery after surgery: the role of the PACU & Pre-op
|
|
|
- Claude Stone
- 5 years ago
- Views:
Transcription
1 Enhanced recovery after surgery: the role of the PACU & Pre-op Magnus K. Teig BSc (Hons.) MBChB MRCP FRCA EDIC FFICM Assistant Professor Anesthesia & Neurosurgery Director UH PACU University of Michigan
2 Learning Objectives 1. Review the evolution and origins of Enhanced Recover after surgery (ERAS) programs and the role of the PACU within them 2. Discuss the future implications of ERAS on the PACU & pre-op areas and on peri-operative practice
3 Disclosures None
4 Acknowledgements Dr. Samantha Hendren Associate Professor of Surgery, Colon & Rectal Surgery Michigan Medicine Dr. Scott Ellis Regenbogen Associate Professor of Surgery, Colon & Rectal Surgery Michigan Medicine Dr. Andrew Gray Urquhart Associate Professor, Orthopedic Surgery Michigan Medicine Dr. Paul Hilliard Assistant Professor, Anesthesia & Pain Michigan Medicine
5 Enhanced Recovery after surgery (ERAS) What is ERAS anyway? Multidisciplinary bundles of care Aim to hasten recovery and shorten stay
6 What is ERAS?
7
8 Where did ERAS begin? Prof. Henrik Khelet MD PhD Colorectal surgeon Hvidovre Hospital (post 2004 Rigshospitalet København) Pre-emptive analgesia - epidurals and nitrogen balance Evolved to fast track surgery mid 1990 s ERAS born 2001
9 From: Henrik Kehlet, M.D., Ph.D., Recipient of the 2014 Excellence in Research Award Anesthes. 2014;121(4): doi: /aln Figure Legend: Henrik Kehlet, M.D., Ph.D., recipient of the American Society of Anesthesiologists 2014 Excellence in Research Award. Date of download: 12/1/2017 Copyright 2017 American Society of Anesthesiologists. All rights reserved.
10 2/outcomes-congress-jan /
11 Kenneth Fearon MBBCh (Hons.), MD, FRCPS (Glasgow), FRCS (Edinburgh), FRCS (England) Royal Infirmary of Edinburgh Founding member of ERAS group Chairman ERAS Society
12 ERAS Societies
13 ERAS USA founded 10/16/2016 ERAS USA, the ERAS Society USA Chapter, held its founding meeting October 16, 2016, at the Marriott Marquis Hotel in Washington, DC. Starting in the preoperative setting, we advise patients to improve their overall health with nutrition, exercise, smoking cessation, and alcohol cessation. Patient education about the surgical process and recovery further brings the patient to the center of their care.
14 ERAS USA Meetings
15
16 Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery Acta Anaesthesiologica Scandinavica Volume 59, Issue 10, pages , 8 SEP 2015 DOI: /aas
17
18 Why bother with ERAS? Colorectal example: Length of stay 2.5 days less Complications - 50% less in colonic surgery Cost - $2,245 per patient 1. U.O. Gustafsson, M.J. Scott,W. Schwenk, N. Demartines, D. Roulin, N. Francis, et al., Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations, World J. Surg. 37 (2) (2012) M. Greco, G. Capretti, L. Beretta,M. Gemma, N. Pecorelli,M. Braga, Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials, World J. Surg. 38 (6) (2014) O. Ljungqvist, E. Jonathan, Rhoads lecture 2011: insulin resistance and enhanced recovery after surgery, J. Parenter. Enter. Nutr. 36 (4) (2012 Jul)
19 ERAS general recommendations 16 different guidelines Do your job well! Surgical themes Anesthesia themes Perioperative nursing and therapy themes
20 Surgical themes Practice asepsis, clean patient in a standard way Use appropriate prophylactic antibiotics Minimally invasive surgery Minimally disruptive preparation Pre-habilitation of patients Minimize fasting and mobilize asap
21 Anesthesia themes Accommodate fasting times Multimodal analgesia Use Neuro-axial / Regional / Local anesthetic Reduce or avoid opiates Reduce fluids if possible Multimodal anti-ponv
22 Perioperative nursing and therapy themes Feed asap Mobilize asap Therapies asap Reduce fasting times Provide aids to get home Patient and family expectations Patient education
23 C'est un effort d'équipe
24 Barriers to ERAS in the PACU Early nutrition in PACU culture change to feed Mobility in the PACU space and staff to assist Reporting back to in room providers perioperative providers versus intra-operative providers Lack of a common protocol for ERAS
25 General surgeon Day 0 problems Reducing fluid boluses for low UO Reducing narcotics often given PACU or on ward Starting nutrition
26 Food in the PACU I never feed my patients! I do not feed them if they are out patients. They might puke! Personal snapshot survey Michigan Medicine PACU, 12/1/2017
27 Post op nutrition options
28 Michigan TKA / THA experience days stay Dealer s choice anesthesia now standardized Clear liquids, PCA, pain service referral
29 Michigan TKA / THA experience Protocolized experience 4.5 hour pre-op course day stay (median <24 hours) Now physical therapy starts in PACU, neuraxial regional anesthesia, clear liquids
30 Perceived barriers to Orthopedic protocol Chicken broth 6 hours fasting (!?) Feeding in the PACU food versus fear of PONV Therapy support and space to mobilize in the PACU PACU holds may delay therapies
31 Orthopedic analgesic protocol
32 Orthopedic experience results RAMP Protocol Traditional Protocol Mean P Value CI, 95% Length of Stay (days) < to -0.4 IV morphine equivalents (mg) Intraoperative < to -2.4 PACU to 0.3 General Floor (Oral) < to General Floor (IV) < to Combined opioid consumption < to LESS READMISSIONS NOW 9% (from 36%)
33 Michigan ERAS - Donor Nephrectomy With thanks to Dr. Seth Waits transplant surgeon Data from Dr. Paul Hilliard
34 Pre Op Smoking Cessation Carbohydrate Drink Acetaminophen (1 gram PO in holding area)
35 Intra Op Post Induction TAP block Standard fluid administration Ketorolac IV at end of case
36 Post Op Scheduled non-narcotic pain medications Early Ambulation Early Regular Diet Improved Discharge Planning
37 Less time in PACU; less time overall Time in PACU Standard therapy n = 40 ERP with TAP block n = Time to incision 50 0 Average time added to induction with TAP block (min) Length of stay in PACU (min)
38 Less opioid use ERP with TAP n = 31 Standard therapy n = PCA use (mg morphine) Total opioid use (including PO) during hospitalization
39 Faster discharge from hospital ERP with TAP Standard Therapy Hospital Length of Stay (in hrs)
40 Similar pain scores in the PACU 5 Post-operative Pain Scores Pain Score (0-10) ERP Standard
41 Less post operative pain on ward Average VAS with ERP Average VAS with standard therapy POD 0 POD 1
42 ERAS and Pre-op Concept of batching patient arrivals and procedures e.g. >1 patient may have an epidural placed; most effective has their operation 1 st Implications on pre-op holding load and staff Letting patients drink in pre-op
43 Why change to adopt ERAS?
44 Why change to adopt ERAS? Learning-Network- MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fac t_sheet_icn pdf
45 Why change to adopt ERAS? Learning-Network- MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fac t_sheet_icn pdf
46 Value Based Purchasing timetable Learning-Network- MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fac t_sheet_icn pdf
47 Why change to adopt ERAS? Pay for performance model Quality valued over quantity
48
49 C'est un effort d'équipe = Team effort
50 How to move ERAS forwards Local and regional collaboration UK example Meetings and education national and international Audit to collect data of successful implementation Work on barriers from staff fasting, analgesia, modes of anesthesia Work on patient education & expectation key to success
51 Eras Society Many different sets of guidelines Commercial products exist to help implement ERAS 8 month program Colorectal Bladder surgery Breast surgery Gastrectomy Bariatic Upper GI Gynaecological Head and neck Pancreaticoduodenectomy Rectal and pelvic
52
53 ERAS Implementation process (UK) Hospital steering groups Audit current practice Milestones agreed Education plan Implement Re-audit
54 1715 hospital days saved
55 ERAS is a continuum The OR and perioperative experience is only 1 small part of it It starts with the H&P at clinic Behavior modification, training and nutrition Hospital stay including anesthetic Rehabilitation & nutrition Post operative mobility & support
56 Questions?
9/29/2017. Enhanced Recovery After Surgery at the University of Virginia Medical Center. Disclosures. Objectives. None
Enhanced Recovery After Surgery at the University of Virginia Medical Center Bethany Sarosiek, RN, MSN, MPH, CNL University of Virginia Health System Charlottesville, VA ErasRN@virginia.edu Disclosures
Enhanced Recovery Implementing Meaningful Change
Enhanced Recovery Implementing Meaningful Change Jeff Simmons MD Associate Professor UAB Department of Anesthesiology and Perioperative Medicine I have no relevant financial relationships to disclose.
Enhanced Recovery in NSQIP (ERIN): an update on the collaborative. Julie Thacker, LianeFeldman, and Julia Berian ACS NSQIP National Conference 2015
Enhanced Recovery in NSQIP (ERIN): an update on the collaborative Julie Thacker, LianeFeldman, and Julia Berian ACS NSQIP National Conference 2015 No disclosures ERIN, ERAS, and ERP ERIN-Enhanced Recovery
Enhanced Recovery After Surgery in OB/GYN
Enhanced Recovery After Surgery in OB/GYN Audra Williams, MD Ashley Wright, MD University of Alabama at Birmingham Department of OB/GYN Women s Reproductive Healthcare Division Outline Brief background
Post-operative "Fast-Track" pathways for lung resection. Dennis A. Wigle Division of Thoracic Surgery Mayo Clinic
Post-operative "Fast-Track" pathways for lung resection Dennis A. Wigle Division of Thoracic Surgery Mayo Clinic Post-operative "Fast-Track" pathways for lung resection Dennis A. Wigle Division of Thoracic
Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3)
Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Goals GOALS AND OBJECTIVES To analyze and interpret
Quality Improvement Initiative (QII): 2018 Options
Quality Improvement Implementation, Option A: Increase Surgeon Engagement Outcome Measure: SSI Summary: Surgeon Engagement is essential for the success of quality improvement programs within hospitals.
Advisor Live Enhanced surgical recovery with perioperative goal-direcred therapy. October 16, #AdvisorLive
Advisor Live Enhanced surgical recovery with perioperative goal-direcred therapy October 16, 2015 @PremierHA #AdvisorLive Download today s slides at www.premierinc.com/events Logistics Audio Use your computer
Oscar Guillamondegui, MD, MPH, FACS Associate Professor of Surgery Tennessee Surgical Quality Collaborative
Oscar Guillamondegui, MD, MPH, FACS Associate Professor of Surgery Tennessee Surgical Quality Collaborative NSQIP 2014 A Collaborative that has Reduced Surgical Site Infections Tennessee Surgical Quality
PSI 12 - Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate Opportunity
MAY 2018 A MESSAGE FROM THE SAINT LUKE S CARE CMO Table of Contents PSI 12 - Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate Opportunity 1,2 NEW Order Sets & Documents 3 Saint Luke s Care
Standardizing for Efficiency: Enhanced Recovery. Lillian S. Kao, MD, MS, CMQ July 23, 2018
Standardizing for Efficiency: Enhanced Recovery Lillian S. Kao, MD, MS, CMQ July 23, 2018 Disclosures Small intestine section editor for UpToDate. ERAS Preoperative Intraoperative Postoperative Enhanced
Enhanced Recovery After Surgery (ERAS) for Elective Colon Resection Surgery at Vancouver General Hospital. What is Possible?
Enhanced Recovery After Surgery (ERAS) for Elective Colon Resection Surgery at Vancouver General Hospital What is Possible? BC Provincial Collaborative November 25, 2014 Disclosure Statement I do not have
2/13/2018. Enhanced Recovery after Surgery (ERAS) in Gynecology
Enhanced Recovery after Surgery (ERAS) in Gynecology J. Michael Straughn, Jr., MD Professor, Gynecologic Oncology University of Alabama at Birmingham Outline What is Enhanced Recovery after Surgery (ERAS)?
Enhanced Recovery Programme
Cancer Action Team Enhanced Recovery Programme Andy McMeeking National Cancer Action Team Andy.McMeeking@gstt.nhs.uk 18 th November 2009 Upper GI Lead Clinicians 1 Enhanced recovery Is a novel approach
Physician Executive Council. Using the Perioperative Surgical Home to Improve Joint Replacement
Physician Executive Council Using the Perioperative Surgical Home to Improve Joint Replacement 9 Today s Presenters Julie Riley Physician Executive Council Senior Consultant 202-266-5628 RileyJu@advisory.com
Perioperative Surgical Home
None Disclosures Debnath Chatterjee, M.D. Associate Professor of Anesthesiology CRASH 2015 - Vail, Colorado 2 Learning Objectives What is the PSH model? Describe the concept of the Perioperative Surgical
Quality improvement for caesarean section - a multifactorial approach. Ian Wrench Consultant Anaesthetist Jessop Wing Obstetric Unit
Quality improvement for caesarean section - a multifactorial approach. Ian Wrench Consultant Anaesthetist Jessop Wing Obstetric Unit Structure of talk: Rationale for introduction of enhanced recovery for
Peri-operative Pain Management - a multi-disciplinary team-based approach
Peri-operative Pain Management - a multi-disciplinary team-based approach Dr Steven Wong Chief of Service Department of Anaesthesiology & OT Services Queen Elizabeth Hospital Outline Development of postoperative
Creating Clinical Pathways
Creating Clinical Pathways Michael Stifelman, MD Professor and Chairman of Urology Director, Urologic Oncology & Courtney DiBona, MSN, RN-BC Nurse Manager: Urology Why create clinical pathways? Institute
Enhancing Recovery After Surgery: Better Teamwork for Better Outcomes 2017
MAYO SCHOOL OF CONTINUOUS PROFESSIONAL DEVELOPMENT Enhancing Recovery After Surgery: Better Teamwork for Better Outcomes 2017 Juanita Kious Waugh Auditorium Mayo Clinic Education Center Phoenix, Arizona
Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath
Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath Up to 25,000 surgical deaths per year 5-10% of surgical cases are high risk 79% of deaths occur in the high risk group Overall
Chinwe Nwosu, GE/NMF Scholar Supervisor: Dr. Stephen Ttendo, Senior Lecturer/ Head of Department of Anesthesia
Chinwe Nwosu, GE/NMF Scholar Supervisor: Dr. Stephen Ttendo, Senior Lecturer/ Head of Department of Anesthesia According to the Uganda Ministry of Health 2010 Clinical Guidelines Read the notes/ medical
Today medical providers are charged with delivering care
The Joint Commission Journal on Quality and Patient Safety 2017; 43:524 533 CARE PROCESSES Optimizing an Enhanced Recovery Pathway Program: Development of a Postimplementation Audit Strategy Michael C.
Open Hysterectomy Enhanced Recovery (HER) (For elective benign hysterectomy, myomectomy and ovarian/adnexal surgery)
CLINICAL PATHWAY Open Hysterectomy Enhanced Recovery (HER) (For elective benign hysterectomy, myomectomy and ovarian/adnexal surgery) Pre-Admission Unit (PAU) Day of Surgery Pre-op Same Day Admission (SDA)
EP13EO Nurses participate in interprofessional groups that implement and evaluate coordinated patient education activities.
EP13EO Nurses participate in interprofessional groups that implement and evaluate coordinated patient education activities. Provide one example, with supporting evidence, of an interprofessional patient
1. Introduction. 1 CMS section
1. Introduction Anesthesiology is the practice of medicine including, but not limited to, preoperative patient evaluation, anesthetic planning, intraoperative and postoperative care and the management
Neck of Femur Enhanced Recovery Programme NOFERP
Neck of Femur Enhanced Recovery Programme NOFERP James Paget University Hospitals NHS Foundation Trust Anthony Morgan, Physiotherapist, Orthopaedic Therapy Team Leader, James Paget University Hospitals
C19: Patients at Home Hours After Total Joint Surgery
C19: Patients at Home Hours After Total Joint Surgery Kaiser Permanente Santa Clara Chris Boyd, Area Manager, Senior Vice President Ashima Garg, MD, PhD, Orthopedic Surgeon Session Objectives Implement
AHRQ Safety Program for Improving Surgical Care and Recovery. ACS Quality and Safety Conference New York City July 21, 2017
AHRQ Safety Program for Improving Surgical Care and Recovery ACS Quality and Safety Conference New York City July 21, 2017 1 Project goals To measurably improve patient outcomes in five surgical areas
Department of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, NC, USA
JEPM Vol XVII, Issue III, July-December 2015 1 Original Article 1 Assistant Professor, Department of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, NC, USA 2 Resident Physician,
Perioperative Essentials for Early Discharge and Outpatient Total Joint Arthroplasty
Perioperative Essentials for Early Discharge and Outpatient Total Joint Arthroplasty R. Michael Meneghini MD Associate Professor of Orthopaedic Surgery Indiana University School of Medicine Indianapolis,
Hip Today Home Tomorrow:
Hip Today Home Tomorrow: A Collaborative Effort between an Orthopedic Practice and a Hospital to Create an Innovative Outpatient Total Hip Replacement Program Kimberley Murray RN MS CNS-CNOR Kelly Keenan
CRNAs Value for Your Team and Bottom Line
CRNAs Value for Your Team and Bottom Line Sarah Chacko, JD Assistant Director of State Government Affairs and Legal Lynn Reede, CRNA, DNP, MBA Senior Director, Professional Practice Becker s 13th Annual
Euclid Hospital CMS BPCI Episode
Euclid Hospital CMS BPCI Episode Two Paradigms in Health Care Reform Managing population 1 health, 2 PCMH Managing episodes of care, Bundled payments Health Status Baseline Episode Total Spend: Commercial
5 th Enhanced Recovery after Surgery Society (UK) Conference, Herriot-Watt University, 6 th November 2015
5 th Enhanced Recovery after Surgery Society (UK) Conference, Herriot-Watt University, 6 th November 2015 Dr Fiona Carter, ERAS UK Manager, contact@erasuk.org Twitter @ERASsocietyUK #ERASUK The ERAS UK
University of Minnesota Anesthesiology Residency Program PEDIATRIC ANESTHESIA ROTATION GOALS AND OBJECTIVES
University of Minnesota Anesthesiology Residency Program PEDIATRIC ANESTHESIA ROTATION GOALS AND OBJECTIVES Goals: The overall goal of the rotation is to provide an introduction and understanding of the
General OR-Stanford-CA-1 revised: Tuesday, February 02, 2016
Stanford University Anesthesiology Residency Program Rotation specific goals and objectives for residents Core Curriculum for PGY 1 Surgery Residents on the Anesthesia Rotation Description: The General
Beth Israel Deaconess Medical Center Perioperative Services Manual. Guidelines for Perioperative Handoffs from OR to receiving units.
Beth Israel Deaconess Medical Center Perioperative Services Manual Title: Guidelines for Perioperative Handoffs from OR to receiving units. Policy #: PSM 100-102A Purpose: This guideline provides a standard
? Prehab, immunonutrition. Safe surgical principles. Optimizing Preoperative Evaluation
Optimizing Preoperative Evaluation Timothy Geiger, MD, MMHC Associate Professor of Surgery Executive Medical Director, Surgery Patient Care Center Chief, Division of General Surgery Director, Colon and
Why Focus on Perioperative Services?
1 Why Focus on Perioperative Services? 80% 60% 40% 20% 0% Perioperative Services are key to a hospital/system's success 68% % better performers revenue from perioperative services Perioperative Services
Implementing an Enhanced Recovery Program for Surgery. Michael F. McGee, MD, FACS, FASCRS September 21, 2017
Implementing an Enhanced Recovery Program for Surgery Michael F. McGee, MD, FACS, FASCRS September 21, 2017 Continuing Education Disclosures Commercial Support or Sponsorship None Speaker or planner relationships
Surgical Oncology II: R5 Tuesday, February 02, 2016
Stanford University General Surgery Residency Program Surgical Oncology II Goals and Objectives for Residents: R-5 Rotation Director: Ralph Greco, MD Description The Surgical Oncology II rotation at Stanford
CLINICAL PATHWAY. Surgical Services. Recurring Ventral Hernia
CLINICAL PATHWAY Surgical Services Recurring Ventral Hernia Recurring Ventral Hernia Table of Contents (tap to jump to page) INTRODUCTION 1 Scope of this Pathway 1 Pathway Contacts 1 CLINICAL PATHWAY 3
Perioperative Fluid Utilization Variability and Association With Outcomes
ORIGINAL ARTICLE Perioperative Fluid Utilization Variability and Association With Outcomes Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations Julie K. M. Thacker, MD, William
PRE OPERATIVE MANAGEMENT FOR PEDIATRIC HOSPITALISTS
Before the Operating Room: PRE OPERATIVE MANAGEMENT FOR PEDIATRIC HOSPITALISTS Presenters: Anjna Melwani, MD Sonaly McClymont, MD David Rappaport, MD Sarah Denniston, MD David Pressel, MD Amy Vinson, MD
NSQIP and Enhanced Recovery After Surgery (ERAS) for Colon Surgery. July252014
NSQIP and Enhanced Recovery After Surgery (ERAS) for Colon Surgery July252014 Outline for the Day Introduction to ERAS overview of ERAS putting a team together importance of education Preoperative and
ASC TOTAL JOINT REPLACEMET
ASC TOTAL JOINT REPLACEMET Mark A. Hartzband, MD Hartzband Center for Hip & Knee Replacement Holy Name Medical Center Hackensack University Medical Center DISCLOSURES Zimmer - Design, Consulting BACKGROUND
Enhanced recovery after bowel surgery
Patient information - Bowel Pre-operative Surgery Enhanced Assessment Recovery - WLE Enhanced recovery after bowel surgery Introduction This leaflet will explain what will happen when you come to the hospital
TOTAL HIP REPLACEMENT FLOW SHEET
TOTAL HIP REPLACEMENT FLOW SHEET Before Surgery: Nothing to eat or drink after midnight the night before surgery. Make sure you have a bowel movement the day before surgery. Be sure to attend your pre-op
Improving Hospital Performance Through Clinical Integration
white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as
Enhanced Recovery The Efficient Way to Help Patients Get Better Sooner After Surgery
Enhanced Recovery The Efficient Way to Help Patients Get Better Sooner After Surgery November 2012 Overview Background Patients journey Aim of the program How have we performed? Can we do more? Questions?
G: Surgical. College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 67
G: Surgical College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 67 Major Competency Area: G Surgical Competency: G-1 Surgical Nursing Date: June 1, 2015 G-1-1 G-1-2 G-1-3
Emerging Trends in Outpatient Orthopedic Strategy
Service Line Strategy Advisor Emerging Trends in Outpatient Orthopedic Strategy April 2015 Cynthia Tassopoulos Analyst Service Line Strategy Advisor TassopoC@advisory.com Road Map 2 1 2 Impetus for Outpatient
The Transformation of Ambulatory Orthopaedic Surgical Anesthesia: A Mixed Methods Study of Diffusion of Innovation in Healthcare
University of New Mexico UNM Digital Repository Collaborative works Orthopedics 3-25-2016 The Transformation of Ambulatory Orthopaedic Surgical Anesthesia: A Mixed Methods Study of Diffusion of Innovation
Highmark Reimbursement Policy Bulletin
Highmark Reimbursement Policy Bulletin Bulletin Number: Subject: RP-033 Anesthesia Services Effective Date: March 12, 2018 End Date: Issue Date: June 11, 2018 Source: Reimbursement Policy Applicable Commercial
Chapter 3M Specialty Nursing Competencies Perioperative (Recovery) Nursing Competency Workbook 6th Edition
Chapter 3M Specialty Nursing Competencies Perioperative (Recovery) Nursing Competency Workbook 6th Edition The Royal Children's Hospital (RCH) Nursing Competency Workbook is a dynamic document that will
Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system
Gramlich et al. Implementation Science (2017) 12:67 DOI 10.1186/s13012-017-0597-5 RESEARCH Open Access Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a
Urology Enhanced Recovery Programme: Laparoscopic/open simple/radical/partial/donor nephrectomy. Information For Patients
Urology Enhanced Recovery Programme: Laparoscopic/open simple/radical/partial/donor nephrectomy Information For Patients 2 This information leaflet aims to help you understand the Enhanced Recovery Programme
Institutional Handbook of Operating Procedures Policy
Section: Admission, Discharge, and Transfer Institutional Handbook of Operating Procedures Policy 9.1.29 Responsible Vice President: EVP & CEO Health System Subject: Admission, Discharge, and Transfer
Hip Replacement Modern Total Hip Replacement in an Ambulatory Surgery Center. A Brief History of Total Hip Replacement
Modern Total Hip Replacement in an Ambulatory Surgery Center James T. Caillouette, M.D. Chairman Newport Orthopedic Institute 1 A Brief History of Total Hip Replacement Hip replacement 1990: LOS 7 Days
Surgical Weight Loss at Eastern Maine Medical Center Your Inpatient Nursing Stay
Surgical Weight Loss at Eastern Maine Medical Center Your Inpatient Nursing Stay Dear Prospective Patient: I have recently been informed that you are considering weight loss surgery at EMMC. As you know
The University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Anesthesia
The University of Arizona Pediatric Residency Program Primary Goals for Rotation Anesthesia 1. GOAL: Maintenance of Airway Patency and Oxygenation. Recognize and manage upper airway obstruction and desaturation.
Duke University Health System Experience of Redesigning Care for Improved Quality and Efficiency CAITLIN DALEY, DR. GEORGE CHEELY, DR.
Duke University Health System Experience of Redesigning Care for Improved Quality and Efficiency CAITLIN DALEY, DR. GEORGE CHEELY, DR. TOM HOPKINS 1 Learning Objectives Describe the Duke University Health
Care of Patients Receiving Analgesia by Catheter Techniques Position Statement and Policy Considerations
Care of Patients Receiving Analgesia by Catheter Techniques Position Statement and Policy Considerations Position Statement Registered nurses (RNs) are valuable members of the patient care team who are
Preparing for Thoracic Surgery and Recovery
Division of Thoracic Surgery Preparing for Thoracic Surgery and Recovery A Guide for Patients and Families Brigham And Women s/faulkner Hospitals Important Phone Numbers Important Phone Numbers BWH NUMBERS
Colorectal Pathway: A Template for the Georgia Surgical Quality Collaborative
Colorectal Pathway: A Template for the Georgia Surgical Quality Collaborative Disclosure Bryant Wilson, MD Relevant Financial Relationships: I have no actual or potential conflict of interest in relation
A PARENT S GUIDE TO PEDIATRIC DAY SURGERY PROVIDENCE MEDICAL CENTER ALASKA PEDIATRIC SURGERY 4100 LAKE OTIS PARKWAY SUITE
ALASKA PEDIATRIC SURGERY 4100 LAKE OTIS PARKWAY SUITE 206 929-7337 A PARENT S GUIDE TO PEDIATRIC DAY SURGERY AT PROVIDENCE MEDICAL CENTER Pre- Admission Appointment, Tours and Pre- Registration If pre-
Goals and Objectives University of Minnesota Department of Anesthesiology Senior Resident Supervising Rotation
UM Anesthesiology Page 1 June, 2007 Introduction Goals and Objectives University of Minnesota Department of Anesthesiology Senior Resident Supervising Rotation The ABA defines the attributes of consultant
Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta
Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta Abstract Introduction: Day care units are playing an increasingly important role in healthcare provision,
ROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY. Dr. Paul Vercruysse M.D. Belgium
ROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY Dr. Paul Vercruysse M.D. Belgium DISCLOSURES - Conflicts of interest? I am an anesthesiologist... TRADITIONAL ROLE OF THE ANESTHESIOLOGIST EVOLVING
SARASOTA MEMORIAL HOSPITAL PERIOPERATIVE DEPARTMENT POLICY
PS1070 SARASOTA MEMORIAL HOSPITAL PERIOPERATIVE DEPARTMENT POLICY TITLE: ADMISSION/DISCHARGE CRITERIA: POST ANESTHESIA CARE UNITS (PACU) EFFECTIVE DATE: REVIEWED/REVISED DATE: POLICY TYPE: Job Title of
Enhanced Recovery after Surgery Considerations for Pathway Development and Implementation
Enhanced Recovery after Surgery Considerations for Pathway Development and Implementation Table of Contents Purpose 2 Introduction 2 The Patient s Interdisciplinary Team 2 Culture and Leadership 3 Enhanced
SCIP-Inf-2, SCIP-Inf-3, SCIP-Inf-4, SCIP-Inf- 9, SCIP-Inf-10, SCIP-VTE-1, SCIP-VTE-2 Anesthesia End Time 5
Release Notes: Alphabetical Data Dictionary Version 3.3 Surgical Care Improvement Project (SCIP) - Data Dictionary The General Abstraction Guidelines explain the different sections of the data element
Your Anesthesiologist, Anesthesia and Pain Control
You should avoid having pain after surgery by planning ahead. For example, if you know that you are going to be getting up to do your exercises with the therapist, ask for pain control medication in advance.
OBSTETRICAL ANESTHESIA
DEPARTMENT OF ANESTHESIA RESIDENCY TRAINING PROGRAM UNIVERSITY OF MANITOBA OBSTETRICAL ANESTHESIA INTRODUCTION Residents will have the opportunity to gain experience in Obstetrical anesthesia in the course
Combined SSI Bundles and ERAS in Colorectal Surgeries
Combined SSI Bundles and ERAS in Colorectal Surgeries Joy Lanfranchi BSN, RN, CNOR, CMLSO Richard Bollin Jr. M.D. Kevin Kinzinger M.D. MBA, FACS, FASCRS Joanne Bonnot MSN, RN, BBA, NE-BC Claudia Skinner
I wish I had written that paper
I wish I had written that paper Sudeep R Shah Consultant GI, HPB & Liver Transplant Surgeon PD Hinduja Hospital, Mumbai 400 016 The I word Personal Philosophical Why do people write papers?????????? Compulsion
Enhanced Recovery Programme for Nephrectomy (Kidney Removal)
Enhanced Recovery Programme for Nephrectomy (Kidney Removal) This information leaflet will explain what will happen when you come to the hospital for your operation. The enhanced Recovery Programme is
GENERAL PROGRAM GOALS AND OBJECTIVES
BENJAMIN ATWATER RESIDENCY TRAINING PROGRAM DIRECTOR UCSD MEDICAL CENTER DEPARTMENT OF ANESTHESIOLOGY 200 WEST ARBOR DRIVE SAN DIEGO, CA 92103-8770 PHONE: (619) 543-5297 FAX: (619) 543-6476 Resident Orientation
Best Practices to Optimize Postoperative Recovery
The OR Management Series Best Practices to Optimize Postoperative Recovery First Edition A compilation of articles from OR Manager OR Manager Elizabeth Wood, Editor Judith M. Mathias, MA, RN, Clinical
The How to Guide for Reducing Surgical Complications
The How to Guide for Reducing Surgical Complications Post operative wound (surgical site) infections Maintaining perioperative normothermia Main contacts for Reducing Surgical Complications Campaign Director:
THE AMERICAN BOARD OF ANESTHESIOLOGY
THE AMERICAN BOARD OF ANESTHESIOLOGY 4208 Six Forks Road, Suite 1500 Raleigh, NC 27609-5765 Phone: (866) 999-7501 Fax: (866) 999-7503 Website: www.theaba.org MOCA PART 4: IMPROVEMENT IN MEDICAL PRACTICE
UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL ANESTHESIOLOGY RESIDENCY PROGRAM GOALS AND OBJECTIVES
UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL ANESTHESIOLOGY RESIDENCY PROGRAM GOALS AND OBJECTIVES CA-2/CA-3 REQUIRED ROTATIONS IN PEDIATRIC ANESTHESIOLOGY The Department of Anesthesiology has established
IHI Expedition. Expedition: Preparing Care Teams for Bundled Payments Session 5: Care Team Redesign
May 19, 2015 Begins at 1:00 PM IHI Expedition Expedition: Preparing Care Teams for Bundled Payments Session 5: Care Team Redesign Trisha Frick, MS, RN Nick Bassett, MBA Lucy Savitz, PhD, MBA Molly Bogan,
A Guide to Enhancing Your Recovery After Bowel Surgery
A Guide to Enhancing Your Recovery After Bowel Surgery Your name: Your Doctor's name: Date of your surgery: Please bring this booklet with you to your pre-admission appointment and your surgery. Introduction
KNOW YOUR BATNA: SHARED RISK AND FUTURE PAYMENT SYSTEMS DISCLOSURES OBJECTIVES
KNOW YOUR BATNA: SHARED RISK AND FUTURE PAYMENT SYSTEMS Stanley W. Stead, M.D., M.B.A. President, Stead Health Group, Inc. Section Chair, ASA Section on Professional Practice AMA Relative Value Update
Minimally Invasive Surgery (MIS) and Open Nephrectomy
P ATIENT INFORMATION Minimally Invasive Surgery (MIS) and Open Nephrectomy (Partial, Radical and Donor) Please bring this book to the hospital on the day of your surgery THE OTTAWA HOSPITAL CP 95 B (03/2013)
Total Joint Arthroplasty Cost Savings With a Rapid Recovery Protocol in a Military Medical Center
MILITARY MEDICINE, 177, 1:64, 2012 Total Joint Arthroplasty Cost Savings With a Rapid Recovery Protocol in a Military Medical Center MAJ David M. Doman, MC USA ; COL Tad L. Gerlinger, MC USA ABSTRACT The
Cost Effectiveness of Physician Anesthesia J.P. Abenstein, M.S.E.E., M.D. Mayo Clinic Rochester, MN
Mayo Clinic Rochester, MN Introduction The question of whether anesthesiologists are cost-effective providers of anesthesia services remains an open question in the minds of some of our medical colleagues,
CURRICULUM VITAE (2/2007 Abbreviated) Bernard Wittels M.D. Ph.D. Associate Professor. Department of Anesthesiology, Rush University Medical Center
CURRICULUM VITAE (2/2007 Abbreviated) Bernard Wittels M.D. Ph.D. Associate Professor Department of Anesthesiology, Rush University Medical Center Education: A.B. (biochemistry), Dartmouth College 1976
Review anesthetic human safety hazards annually with all hospital associates. Designate dedicated anesthetic induction and recovery areas.
Designate dedicated anesthetic induction and recovery areas. Review anesthetic human safety hazards annually with all hospital associates. What are the advantages of having dedicated areas? How would induction
Guidelines for patients undergoing surgery as part of an Enhanced Recovery Programme (ERP)
Guidelines for patients undergoing surgery as part of an Enhanced Recovery Programme (ERP) Summary Helping you to get better sooner after surgery June 2012 Foreword These guidelines have been produced
Enhanced Recovery: Measurement for Improvement Monthly Data Submission Guidance. Version 1.0
Enhanced Recovery: Measurement for Improvement Monthly Data Submission Guidance Version 1.0 Document Control Version Version 1.0 Date Issued January 2014 Document To provide guidance for the monthly collection
Enhanced Recovery After Surgery
Enhanced Recovery After Surgery Thomas Aloia, MD, FACS and Vijaya Gottumukkala, MB, BS, MD (Anes), FRCA The University of Texas MD Anderson Cancer Center March 7 8, 2017 Welcome Ask a question using the
Your guide to surgery at Edward Hospital
Your guide to surgery at Edward Hospital Please use this guide to help you know how to prepare for your surgery and what to expect on the day of surgery. Your Guide to Surgery Important information Your
Welcome to Baylor Scott & White Hillcrest. A Perioperative Services Orientation
Welcome to Baylor Scott & White Hillcrest A Perioperative Services Orientation What does "Perioperative" mean? When a patient is cared for in the Perioperative setting, they receive care preoperatively,
Reviewing your 2017 CMS Quality Reports
Reviewing your 2017 CMS Quality Reports Anesthesia Quality Institute aqihq.org November 2017 Reviewing 2017 CMS Quality Reports - Monitor your providers measure compliance monthly using your NACOR/ArborMetrix
Fast Track Hip and Knee Replacement Marginal Gains
Fast Track Hip and Knee Replacement Marginal Gains Paul Partington Arthroplasty Lead Northumbria Trust Fast Track Hip and Knee Replacement Marginal Gains Paul Partington Arthroplasty Lead Northumbria Trust
Session 2 Improving Narcotics and Opiate Management
Session 2 Improving Narcotics and Opiate Management Frank Federico, RPh, IHI Executive Director Steve Meisel, Pharm.D., IHI Faculty January 31,2012 12:00-1:00pm ET Beth O Donnell, MPH Beth O Donnell, MPH,
Improving RCTs in surgery: describing
Improving RCTs in surgery: describing standardising & monitoring interventions Jane M Blazeby Professor of Surgery & Honorary Consultant Surgeon, Director MRC ConDuCT-II Hub for Trials Methodology Research