Julie Thacker MD Gretchen VanDerBosch RD LDN Copyright 2019 DC JT GV All Rights Reserved Disclosure Statement Julie Thacker Merck Cheetah Sandoz speakers Bureau Gretchen VanDerBosch ID: 809875
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Slide1
ERAS: It’s Not Always About Anesthesia: TeamworkJulie Thacker, MDGretchen VanDerBosch, RD, LDN
Copyright 2019. DC, JT, GV. All Rights Reserved.
Slide2Disclosure StatementJulie ThackerMerck Cheetah, Sandoz speakers BureauGretchen
VanDerBosch
Abbott speaker bureau
Desiree Chappell
Speakers Bureau- Edwards Lifesciences, Medtronic
Board of Directors- American Society for Enhanced Recovery
Co-Director- Evidenced Based Perioperative Medicine, USA
Co-founder- Perioperative Coaching Company, PoCCo
Managing Editor- TopMedTalk
Slide3Learner OutcomesDiscuss collaborative leadership to engage across specialties to bring the best to each patient at the right time.Outline best communication processes for continuity of care and outcomes.
Slide4Panelists
Julie Thacker, MD
Colorectal Surgeon
Duke University
Durham, NC
Slide5SURGEON’S EXPEREINCEDUKEACS/SAGESPATIENT POPULATION/OUTCOMESERAS TEAM
Slide6DIETICIAN’S PERSPECTIVEBEING PART OF THE TEAMLEADING THE TEAMNUTRTION AS A CORNERSTONE OF ERAS
Slide7GETTING A PROGRAM STARTEDFORMING THE TEAMFRAMEWORK OF THE PROGRAMTOP-DOWN SUPPORT FROM ADMINSITRATIONGRASS-ROOTS PROGRAMINCENTIVING? BRIBERY
Slide8SUSTAINABILITYHOW TO MAKE IT STICK?HOW TO EXPAND THE TEAM
Slide9EPOCHhttp://epochtrial.org/epoch.php
Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial
Slide10Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial ‘Implications of all the available evidence Despite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.'
Slide11NUTRITION FOR SURGICAL PATIENTSMULTIDICIPLINARY TEAM APPROACH
Slide12NUTRITIONAL STATUS IS PROGRESSIVELY COMPROMISED OVER THE CONTINUUM OF CARE
1. Sriram K, Sulo S, VanDerBosch G, et al
. J
Parenter
Enteral
Nutr
. 2016;1-8
. http://journals.sagepub.com/doi/abs/10.1177/0148607116681468.
2.
Gariballa
S,
Elessa
A.
Clinical Nutrition.
2013; http://dx.doi.org/10.1016/j.clnu.2013.01.010.
3.
Allaudeen
N,
Vidyarthi
A,
Maselli
J, Auerbach A.
J Hosp Med.
2011;6:54
–60.
30% to 50%
of patients
a
r
e malnourished
upon
admission
1
Weight
loss and loss of muscle increase risk of readmissions2,3
Many patients with normal nutrition status experience a decline during hospitalization1
Upon Admission to the Hospital
During Hospital Stay
Post-discharge
Slide13UNRECOGNIZED MALNUTRITION CAN LEAD TO COSTLY CONSEQUENCES 1. Philipson TS, Thorton Snider J, Lakdawalla DN, et al. Am J Manag Care. 2013;19(2):121-128.
2.
Shahin
ES et al.
Nutrition.
2010;26(9):886-889.
Inc
r
eased
LOS
1
Inc
r
eased cost of care
1
Inc
r
eased
morbidity/mortality
1
Higher
complication rates
1
Increased risk of
pressure ulcers
2
Inc
r
eased
r
eadmission
rates
1
Slide14How do we find the Malnourished patients?Malnutrition Screen Tool (MST)Perioperative Nutrition Screen (PONS)Strong for Surgery
Slide15Strong For Surgery
Slide16Validated Malnutrition Screening Tool (MST)
Slide17Perioperative Nutrition Screen (PONS)4
4.
Wischmeyer
, P.E., et al
.
Anesthesia & Analgesia
, Online: Jan 23, 2018
.
Slide18Resources/ ReferencesAANA ERAS list of referencesAanahq.org/enhancedrecoveryAmerican Society for Enhanced Recovery
Aserhq.org
Perioperative Quality Initiative
poqi.org
ERAS Society Guidelines
Erassociety.org
EPOCH
http://
epochtrial.org
/
epoch.php