加强手术后恢复计划的挑战和机遇:概述
Vijaya Gottumukkala1, Girish P Joshi2
1Department of Anesthesiology and Perioperative Medicine, Program for Advancement of Perioperative Cancer Care, Division of Anesthesiology, Critical Care and Pain Medicine, Institute for Cancer Care Innovation; Institutional Enhanced Recovery Program, The University of Texas MD Anderson Cancer Center, Dallas TX, USA.
Indian journal of anaesthesia
|December 11, 2024
概括
手术后增强恢复 (ERAS) 计划通过减少并发症和住院时间来改善手术结果. 有效实施需要强有力的领导和持续的质量改进,以实现广泛采用.
科学领域:
- 在外科手术期间的医学.
- 手术结果研究研究.
- 医疗保健管理的管理
背景情况:
- 手术后增强恢复 (ERAS) 计划是基于证据的,多学科的干预措施,旨在最大限度地减少手术压力,减少并发症,并在所有外科手术阶段改善患者的结果.
- 虽然ERAS计划已经显示出积极的结果,包括医疗并发症减少,住院时间缩短,成本降低而不增加再入院,但它们的广泛实施一直是具有挑战性的.
研究的目的:
- 突出了必要的关键组成部分,以实现ERAS计划的强大和普遍采用.
- 强调有效的变革管理,临床领导和ERAS实施中的持续质量改进的重要性.
- 为评估ERAS干预措施的未来研究方法提供指导.
主要方法:
- 对基于证据的实践和医疗保健变化管理原则的审查.
- 强调持续质量改进 (CQI) 框架,包括快速循环,随机/准随机质量改进项目.
- 讨论开发和实施途径的研究方法,重点关注遵守和个人干预的有效性.
主要成果:
- 埃拉斯计划与医疗并发症和住院时间的显著减少有关.
- 成功实施ERAS取决于有效的变革管理,积极的临床领导和数据驱动的途径开发.
- 低于最佳的实施是常见的,表明需要采用结构化的方法.
结论:
- 强有力的ERAS计划的采用需要有效的变革管理和持续的质量改进的基础.
- 未来的研究应该优先控制遵守ERAS核心元素,并使用随机对照试验来评估个别干预的有效性.
- 积极的临床领导和数据驱动的路径调整对于最大限度地发挥ERAS计划的好处至关重要.
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