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RESUMEN El protocolo de recuperación optimizada Enhanced Recovery After Surgery (ERAS®) se puso en marcha a partir de 2013 en el sistema de salud de Alberta, un sistema estatal de cobertura médica totalmente financiado con fondos provinciales. Su aplicación en cirugía colorrectal en múltiples centros provincia les disminuyó la incidencia de complicaciones en un 12% y redujo la estancia hospitalaria en un día. Posteriormente, la introducción del programa en ginecología oncológica redujo las complicaciones postoperatorias en un 17% y la duración de la estancia en 2 días en los procedimientos quirúrgicos complejos. Se estima que la ejecución del programa produjo un ahorro neto de 7,22 millones de dóla res canadienses (CAD) en 5 años para la provincia, con un rendimiento de la inversión de 1,05 a 7,31 dólares por cada dólar invertido en el proyecto. La participación de los pacientes permitió que el pro grama tuviera éxito, y el apoyo, la educación y la atenuación del estrés de los pacientes se identificaron como los componentes principales del éxito. El conocimiento y la motivación de los profesionales sani tarios fueron esenciales para garantizar el cumplimiento continuo de las recomendaciones del progra ma ERAS. La educación de los profesionales sanitarios y la demostración de la mejora de los resultados de los pacientes mediante supervisiones es una forma de garantizar que los profesionales sanitarios sigan motivados. Es esencial contar con líderes en el sistema de salud para proporcionar un mensaje coherente y apoyar las iniciativas. El liderazgo también es importante entre los médicos y coordina dores de enfermería para garantizar el cumplimiento y la integración adecuada de la recuperación optimizada en la práctica diaria. La aplicación del programa ERAS en un sistema de salud unificado ha mejorado los resultados de los pacientes y ahorrado recursos. Se está investigando la posibilidad de ampliar el programa a los hospitales comunitarios y a todos los ámbitos quirúrgicos.
ABSTRACT Enhanced Recovery After Surgery (ERAS®) was implemented across Alberta Health Services, a single payer publicly funded provincial health system starting in 2013. Implementation across multiple provincial sites in colorectal surgery reduced postoperative complications by 12% and median length of stay by one day. Subsequent implementation in gynecologic oncology reduced postoperative complications by 17% and length of stay by 2 days in high complexity surgery. Implementation has had an estimated net savings in the province of $7.22 million Canadian dollars (CAD) over 5 years with a return on investment of $1.05 to $7.31 for every dollar invested in the project. Patient involvement enabled success of the program, with support, education, and mitigation of patient stress identified as key components for success. Provider knowledge and motivation were essential to ensure ongoing compliance with ERAS guidelines. Provider education, and demonstration of improvement in patient outcomes using audit is one method to ensure continued motivation from care providers. System-level leadership is essential to provide consistent messaging and support for initiatives, while provider-level leadership in the form of physician champions and nurse coordinators ensures compliance and appropriate integration of ERAS into daily practice. Implementation of ERAS across a unified health care system has improved patient outcomes while saving resources. Further research into expansion of the program to community hospitals and all surgical domains is underway.
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BACKGROUND: Since 2005, the Canadian home parenteral nutrition (HPN) registry has collected data on patients' demography, outcomes, and HPN clinical practice. At annual meetings, Canadian HPN programs review and discuss results. AIM: To evaluate changes over time in patient demography, outcomes, and HPN clinical practice using the registry data. METHODS: This retrospective study evaluated 369 patients who were prospectively entered in the registry. Two periods were compared for the first data entry: 2005-2008 (n = 182) and 2011-2014 (n = 187). Patient demography, indications for HPN, HPN regimen, nutrition assessment, vascular access, and number of line sepsis per 1000 catheter days were evaluated. RESULTS: For 2011-2014 compared with 2005-2008, indications for HPN changed significantly, with an increased proportion of patients with cancer (37.9% vs 16.7%) and with fewer cases of short bowel syndrome (32% vs 65.5%); line sepsis rate decreased from 1.58 to 0.97 per 1000 catheter days; and the use of tunneled catheters decreased from 64.3% to 38.0% and was no longer the most frequently chosen vascular access method. In contrast, the proportion of peripherally inserted central catheters increased from 21.6% to 52.9%. In addition, there was a reduction in number and days of hospitalizations related to HPN, and favorable changes were noted in the prescription of energy, proteins, and trace elements. CONCLUSION: The Canadian HPN registry is useful in tracking trends in demography, outcomes, and clinical practice. Results suggest a shift in patient demography and line access with improvement in line sepsis, hospitalizations, and HPN prescriptions.