Deborah S Keller1, Conor P Delaney2, Anthony J Senagore3, Liane S Feldman4. 1. Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, 3500 Gaston Street, R-1013, Dallas, TX, 75204, USA. debby_keller@hotmail.com. 2. Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 3. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. 4. Department of Surgery, McGill University, Montreal, QC, Canada.
Abstract
BACKGROUND: The SAGES Surgical Multimodal Accelerated Recovery Trajectory (SMART) Enhanced Recovery Task Force aims to increase awareness and provide tools for members to successfully implement enhanced recovery pathways (ERPs) to improve clinical outcomes and patient satisfaction. An initial step was to survey SAGES member on their knowledge, use, and impediments to enhanced recovery. METHODS: An online survey designed by SMART committee members to define SAGES member's awareness and use of enhanced recovery principles and practice was emailed to all SAGES members. Reminders were sent 2 and 3 weeks later, encouraging completion of the survey. The web-based survey included 48 questions and took an estimated 20 min to complete. RESULTS: A total of 229 members completed the survey. Respondents were primarily general/MIS surgeons (82.6%) working in an urban location (85.5%), with a bell-shaped age distribution (median 35-44). Almost half regularly used some elements of ERPs (48.7%), but 30% were unfamiliar with the concept. Wide variety in the specific ERP elements used and discharge criteria were reported. The majority had to create and implement their own plan (70.4%). Roadblocks to implementation were inconsistencies with partners/covering physicians (56.3%), nursing education (46.6%), and resources (34.7%). When implemented, members saw improvements in length of stay (88%), patient satisfaction (54.7%), postoperative pain (53.3%), time to return of bowel function (52.7%), and readmissions (16.7%). A need for education and standardization was especially seen in preoperative care, with 74.4% fasting patients from midnight the night before surgery. Wide variations were also reported in pain management practices. An overwhelming majority (89%) reported that having a protocol endorsed by a national organization, such as SAGES, would help with implementation. CONCLUSIONS: From this survey of SAGES members, there is a need for education, tools, and standardized protocols to increase awareness, support implementation, and encourage wider utilization of ERP. The overwhelming majority stated having a protocol endorsed by a national organization, such as SAGES, would facilitate implementation.
BACKGROUND: The SAGES Surgical Multimodal Accelerated Recovery Trajectory (SMART) Enhanced Recovery Task Force aims to increase awareness and provide tools for members to successfully implement enhanced recovery pathways (ERPs) to improve clinical outcomes and patient satisfaction. An initial step was to survey SAGES member on their knowledge, use, and impediments to enhanced recovery. METHODS: An online survey designed by SMART committee members to define SAGES member's awareness and use of enhanced recovery principles and practice was emailed to all SAGES members. Reminders were sent 2 and 3 weeks later, encouraging completion of the survey. The web-based survey included 48 questions and took an estimated 20 min to complete. RESULTS: A total of 229 members completed the survey. Respondents were primarily general/MIS surgeons (82.6%) working in an urban location (85.5%), with a bell-shaped age distribution (median 35-44). Almost half regularly used some elements of ERPs (48.7%), but 30% were unfamiliar with the concept. Wide variety in the specific ERP elements used and discharge criteria were reported. The majority had to create and implement their own plan (70.4%). Roadblocks to implementation were inconsistencies with partners/covering physicians (56.3%), nursing education (46.6%), and resources (34.7%). When implemented, members saw improvements in length of stay (88%), patient satisfaction (54.7%), postoperative pain (53.3%), time to return of bowel function (52.7%), and readmissions (16.7%). A need for education and standardization was especially seen in preoperative care, with 74.4% fasting patients from midnight the night before surgery. Wide variations were also reported in pain management practices. An overwhelming majority (89%) reported that having a protocol endorsed by a national organization, such as SAGES, would help with implementation. CONCLUSIONS: From this survey of SAGES members, there is a need for education, tools, and standardized protocols to increase awareness, support implementation, and encourage wider utilization of ERP. The overwhelming majority stated having a protocol endorsed by a national organization, such as SAGES, would facilitate implementation.
Authors: K C H Fearon; O Ljungqvist; M Von Meyenfeldt; A Revhaug; C H C Dejong; K Lassen; J Nygren; J Hausel; M Soop; J Andersen; H Kehlet Journal: Clin Nutr Date: 2005-04-21 Impact factor: 7.324
Authors: P M King; J M Blazeby; P Ewings; P J Franks; R J Longman; A H Kendrick; R M Kipling; R H Kennedy Journal: Br J Surg Date: 2006-03 Impact factor: 6.939
Authors: U O Gustafsson; M J Scott; W Schwenk; N Demartines; D Roulin; N Francis; C E McNaught; J Macfie; A S Liberman; M Soop; A Hill; R H Kennedy; D N Lobo; K Fearon; O Ljungqvist Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: U O Gustafsson; M J Scott; W Schwenk; N Demartines; D Roulin; N Francis; C E McNaught; J MacFie; A S Liberman; M Soop; A Hill; R H Kennedy; D N Lobo; K Fearon; O Ljungqvist Journal: Clin Nutr Date: 2012-09-28 Impact factor: 7.324
Authors: Pascal H E Teeuwen; Robert P Bleichrodt; Paul J M de Jong; Harry van Goor; Andre J A Bremers Journal: Dis Colon Rectum Date: 2011-07 Impact factor: 4.585
Authors: Malaika S Vlug; Jan Wind; Markus W Hollmann; Dirk T Ubbink; Huib A Cense; Alexander F Engel; Michael F Gerhards; Bart A van Wagensveld; Edwin S van der Zaag; Anna A W van Geloven; Mirjam A G Sprangers; Miguel A Cuesta; Willem A Bemelman Journal: Ann Surg Date: 2011-12 Impact factor: 12.969
Authors: Julia R Berian; Kristen A Ban; Jason B Liu; Christine L Sullivan; Clifford Y Ko; Julie K M Thacker; Liane S Feldman Journal: JAMA Surg Date: 2018-04-01 Impact factor: 14.766