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Making enhanced recovery the norm not the exception.

Authors
  • Slakey, D P1
  • Silver, D S2
  • Chazin, S M3
  • Katoozian, P Y4
  • Sikora, K S4
  • Ruther, M M4
  • 1 Advocate Aurora Health, United States. Electronic address: [email protected] , (United States)
  • 2 University of Pittsburgh Department of Surgery, United States. , (United States)
  • 3 Tulane University School of Medicine, United States. , (United States)
  • 4 Advocate Aurora Health, United States. , (United States)
Type
Published Article
Journal
American journal of surgery
Publication Date
Mar 01, 2020
Volume
219
Issue
3
Pages
472–476
Identifiers
DOI: 10.1016/j.amjsurg.2019.09.018
PMID: 31551144
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Enhanced Recovery After Surgery ("STAAR" in our system) is multimodal care focused on the reduction of physiological and psychological stress. While enhanced recovery is well established in colorectal surgery, and there is evidence for effectiveness in other surgical disciplines, to date widespread use is limited. We implemented a Lean process that, within 12 months, expanded STAAR to 13 surgical services lines involving >130 surgeons, and impacting the care of >6000 surgical patients/year. Implementation involved educational and administrative meetings (279 in the first 6 months) and rounding. Use of STAAR was defined as >60% compliance. LOS was reduced up to 40%, mortality index and transfusion decreased 67% and 23% respectively. Case mix index increased 17%. Readmission rates, infections, ER visits were not increased. Using a Lean process focused on value, STAAR protocols became the standard rather than the exception. Time investment by senior surgical leadership was extensive. Copyright © 2019 Elsevier Inc. All rights reserved.

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