Implementation Materials

Created: October 01, 2023

Last Updated: June 11, 2024

Contributor(s):

Cheryl Crisafi MSN RN CNL

Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC

Gina McConnell RN BSN CCRN

Shannon Crotwell RN BSN CCRN

Vicki Morton DNP MSN AGNP-BC

Editor(s):

Cheryl Crisafi MSN RN CNL

Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC

Gina McConnell RN BSN CCRN

Shannon Crotwell RN BSN CCRN

Vicki Morton DNP MSN AGNP-BC

Alexander Gregory MD FRCPC

Summary

The Virtual Training Center (VTC) is a platform to provide educational resources to healthcare providers who are interested in Enhanced Recovery After Surgery (ERAS) programs for cardiac surgery patients. As a supplement to the virtual presentations and panel discussions provided in the VTC we have developed implementation templates and materials to act as a tool kit to aid in the process of developing your own institutional ERAS program.

ERAS Patient Education Booklet

This editable patient education booklet is designed to provide the patient with education about enhanced recovery for cardiac surgery.


ERAS Clinical Pathway

An editable pathway is a guide listing out the elements of an ERAS program. It is organized by the phases of care and responsible parties.


ERAS Implementation Checklist

This editable checklist is to assist a team in the steps to implement an enhanced recovery program.


ERAS Coordinator Job Description

This editable document has been designed to assist creating a job description for an enhanced recovery after surgery coordinator position.


ERAS Cardiac Implementation and Staff Education PowerPoint

This editable PowerPoint is designed to assist with standardized education of the healthcare team and implementation of an enhanced recovery after surgery program for cardiac surgery patients. It includes all the elements of the initial guidelines with rationales.


ERAS 1.0 Data Dashboard

This editable Excel sheet has been designed to assist new programs with which elements are key to include in data collection set.

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ERAS Cardiac VTC Disclaimer:

The VTC, and all included content, is intended to inform ERAS Cardiac Members in a multitude of topics related to enhanced recovery. The information included has been provided by other enhanced recovery experts and should be used for educational purposes only. It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered as formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information on the VTC is accurate or complete in every respect. Therefore, ERAS Cardiac Society is not responsible for any errors or omissions in the content, or medical results that occur with the application of the information obtained while using the VTC. All healthcare professionals should continue to use sound clinical judgment and prescribe therapies based on the best medical knowledge at their disposal.

All the material presented on the VTC is the intellectual property of the ERAS Cardiac Society, its contributors, and its sponsors. Unless explicitly stated, the information, images, audio, video, and other content may not be reproduced (in whole or in part) in any way without the written permission of the ERAS Cardiac Society.

If you have any questions or comments about the ERAS Cardiac VTC, please email: VTC@erascardiac.org

Educational Materials

References:

1. Abu-Omar Y, Kocher GJ, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017;51(1):10-29.

2. Arora RC, Brown CHt, Sanjanwala RM, McKelvie R. "NEW" Prehabilitation: A 3-Way Approach to Improve Postoperative Survival and Health-Related Quality of Life in Cardiac Surgery Patients. Can J Cardiol. 2018;34(7):839-849.

3. Balfour A, Burch J, Fecher-Jones I, Carter FJ. Exploring the fundamental aspects of the Enhanced Recovery After Surgery nurse's role. Nursing standard (Royal College of Nursing (Great Britain) : 1987). 2019.

4. Brescia AA, Clark MJ, Theurer PF, et al. Establishment and Implementation of Evidence-Based Opioid Prescribing Guidelines in Cardiac Surgery. Ann Thorac Surg. 2021;112(4):1176-1185.

5. Brown JK, Shaw AD, Mythen MG, et al. Adult Cardiac Surgery-Associated Acute Kidney Injury: Joint Consensus Report. J Cardiothorac Vasc Anesth. 2023;37(9):1579-1590.

6. Brown JK, Singh K, Dumitru R, Chan E, Kim MP. The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery. Methodist Debakey Cardiovasc J. 2018;14(2):77-88.

7. Chatterjee S, Arora RC, Crisafi C, et al. State of the art: Proceedings of the American Association for Thoracic Surgery Enhanced Recovery After Cardiac Surgery Summit. JTCVS Open. 2023;14:205-213.

8. Cooper SL, Panesar P. Preoperative optimization and enhanced recovery after surgery. Surgery (United Kingdom). 2019;37(12):700-705.

9. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg. 2019;154(8):755-766.

10. Eskicioglu C, Forbes SS, Aarts MA, Okrainec A, McLeod RS. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg. 2009;13(12):2321-2329.

11. Grant MC, Chappell D, Gan TJ, Manning MW, Miller TE, Brodt JL. Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society. J Thorac Cardiovasc Surg. 2023.

12. Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg. 2020;159(4):1393-1402.e1397.

13. Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. Journal of Thoracic and Cardiovascular Surgery. 2020;159(4):1393-1402.e1397.

14. Guinn NR, Schwartz J, Arora RC, et al. Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients. Anesth Analg. 2022;135(3):532-544.

15. Hill A, Nesterova E, Lomivorotov V, et al. Current Evidence about Nutrition Support in Cardiac Surgery Patients-What Do We Know? Nutrients. 2018;10(5).

16. Hirji SA, Salenger R, Boyle EM, et al. Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery. World J Surg. 2021;45(4):917-925.

17. Jawitz OK, Bradford WT, McConnell G, Engel J, Allender JE, Williams JB. How to Start an Enhanced Recovery After Surgery Cardiac Program. Crit Care Clin. 2020;36(4):571-579.

18. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961-969.

19. Laudun S, Parrino E. Using a Multidisciplinary Approach for the Reduction of Ventilator Hours in Coronary Artery Bypass Graft. Ochsner Journal. 2019;19(1):e17.

20. Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg. 2016;152(4):962-972.

21. Li P, Qu LP, Qi D, et al. Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review. Ann Med. 2017;49(4):343-351.

22. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152(3):292-298.

23. Lu SY, Lai Y, Dalia AA. Implementing a Cardiac Enhanced Recovery After Surgery Protocol: Nuts and Bolts. J Cardiothorac Vasc Anesth. 2020;34(11):3104-3112.

24. McCarthy C, Fletcher N. Early Extubation in Enhanced Recovery from Cardiac Surgery. Crit Care Clin. 2020;36(4):663-674.

25. McConnell G, Woltz P, Bradford WT, Ledford JE, Williams JB. Enhanced recovery after cardiac surgery program to improve patient outcomes. Nursing. 2018;48(11):24-31.

26. Mertes PM, Kindo M, Amour J, et al. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med. 2022;41(3):101059.

27. Miller TE, Myles PS. Perioperative Fluid Therapy for Major Surgery. Anesthesiology. 2019;130(5):825-832.

28. Mori M, Angraal S, Chaudhry SI, et al. Characterizing Patient-Centered Postoperative Recovery After Adult Cardiac Surgery: A Systematic Review. J Am Heart Assoc. 2019;8(21):e013546.

29. Morton-Bailey V, Salenger R, Engelman DT. The 10 Commandments of ERAS for Cardiac Surgery. Innovations (Phila). 2021;16(6):493-497.

30. Najjar PA, Whang EE, Urman RD, McGrath CT, Beloff JR, Bleday R. Institution-wide Implementation Strategies, Finance, and Administration for Enhanced Recovery after Surgery Programs. International Anesthesiology Clinics. 2017;55(4):90-100.

31. Noss C, Prusinkiewicz C, Nelson G, Patel PA, Augoustides JG, Gregory AJ. Enhanced Recovery for Cardiac Surgery. J Cardiothorac Vasc Anesth. 2018;32(6):2760-2770.

32. Pajares MA, Margarit JA, García-Camacho C, et al. Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP). Rev Esp Anestesiol Reanim (Engl Ed). 2021;68(4):183-231.

33. Pickens RC, Cochran AR, Lyman WB, et al. Impact of Multidisciplinary Audit of Enhanced Recovery After Surgery (ERAS)® Programs at a Single Institution. World J Surg. 2021;45(1):23-32.

34. Pickens RC, Cochran AR, Lyman WB, et al. Impact of Multidisciplinary Audit of Enhanced Recovery After Surgery (ERAS)® Programs at a Single Institution. World J Surg. 2021;45(1):23-32.

35. Pooya S, Johnston K, Estakhri P, Fathi A. Successful Implementation of Enhanced Recovery After Surgery Program in a Safety-Net Hospital: Barriers and Facilitators. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses. 2021.

36. Salenger R, Morton-Bailey V, Grant M, Gregory A, Williams JB, Engelman DT. Cardiac Enhanced Recovery After Surgery: A Guide to Team Building and Successful Implementation. Semin Thorac Cardiovasc Surg. 2020;32(2):187-196.

37. Stone AB, Yuan CT, Rosen MA, et al. Barriers to and Facilitators of Implementing Enhanced Recovery Pathways Using an Implementation Framework: A Systematic Review. JAMA Surg. 2018;153(3):270-279.

38. Stoppe C, Goetzenich A, Whitman G, et al. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Crit Care. 2017;21(1):131.

39. Tippireddy S, Ghatol D. Anesthetic Management for Enhanced Recovery After Major Surgery (ERAS). StatPearls. Treasure Island (FL): StatPearls Publishing

Copyright © 2023, StatPearls Publishing LLC.; 2023.

40. Watson DJ. Nurse coordinators and ERAS programs. Nurs Manage. 2018;49(1):42-49.

41. Williams JB, McConnell G, Allender JE, et al. One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg. 2019;157(5):1881-1888.

42. World Health Organization. (2019, March 9). Patient safety. www.who.int. https://www.who.int/news-room/...

42. Yazdchi F, Hirji S, Harloff M, et al. Enhanced Recovery After Cardiac Surgery: A Propensity-Matched Analysis. Semin Thorac Cardiovasc Surg. 2022;34(2):585-594.