At Virginia Commonwealth University System (VCU Health) in Richmond, we are using quality standards to establish operational definitions for elements of Enhanced Recovery After Surgery (ERAS). This article describes what those standards are and how they are implemented. Previous articles in this series appeared in the October 2019 and November…

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Editor's Note An Enhanced Recovery Pathway (ERP) created by the Mayo Clinic’s colorectal surgery service a decade ago has now been adopted by other surgical services in seven medical centers that are members of the Mayo Clinic Care Network, the October 15 Harvard Business Review reports. The ability of each…

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Our series on Enhanced Recovery After Surgery (ERAS), which began last month with an overview of its history and perioperative pathway, continues in this issue with examples of improved outcomes and the roles played by perioperative team members (see p 18). ERAS, known to speed recovery and increase patient satisfaction,…

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The US has been on a journey for the last several years to reduce the cost of healthcare. In 2017, the percent of gross domestic product attributed to healthcare goods and services was at 17.9%. This is expected to reach as much as 19.4% by the year 2027.1 Factors contributing…

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Editor's Note In this study, heart failure with or without symptoms was associated with an increased risk of postoperative mortality at 90-days and complications at 30-days in ambulatory surgery patients. In this analysis of 355,121 patients having noncardiac ambulatory surgical procedures, 90-day mortality was 2% in patients with heart failure…

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Enhanced Recovery After Surgery (ERAS®) is a comprehensive, multifaceted, and multidisciplinary approach to the care of the surgical patient. ERAS bundles evidence-based elements to facilitate a faster recovery with fewer complications.1 Spanning the continuum of perioperative care, ERAS elements include: • patient engagement and education • preoperative optimization of nutrition…

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Hospital-acquired pressure injuries (HAPIs) fall under the care management serious event category, and the literature suggests the incidence of a pressure injury following surgery or a procedure may contribute to more than half of all hospital-related skin injuries. Furthermore, the Centers for Medicare & Medicaid Services (CMS) has defined numerous…

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About 2 years ago I was diagnosed with prostate cancer. As I researched the treatment alternatives, I became very concerned about the complications associated with traditional surgical prostatectomy or radiation. Then I learned that I might be eligible for an outpatient procedure: high-intensity focused ultrasound (HIFU). Although HIFU is relatively…

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Editor's Note Music is a viable alternative to IV midazolam in reducing anxiety before a preoperative peripheral nerve block, this study finds. A total of 157 adult patients were randomly assigned to one of two options 3 minutes before peripheral nerve block−either an injection of 1-2 mg of midazolam or…

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Editor's Note Use of opioids and benzodiazepines 6 months before surgery was associated with increased short- and long-term mortality and an increased rate of persistent postoperative opioid consumption, this study finds. In this analysis of 41,170 noncardiac surgical cases in 27,787 patients in Iceland, preoperative prescriptions for opioids only were…

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