Realising the full potential of anaesthesiology to promote enhanced recovery after surgery programmes in China

Editor—Enhanced recovery after surgery (ERAS) has been developed and widely applied in many surgical procedures worldwide.1Smith Jr., T.W. Wang X. Singer M.A. Godellas C.V. Vaince F.T. Enhanced surgery: a clinical review of implementation across multiple subspecialties.Am J Surg. 2020; 219: 530-534Abstract Full Text PDF PubMed Scopus (30) Google Scholar However, different departments teams tend to sponsor lead ERAS programmes independently according their specific requirements.2Ljungqvist O. Scott M. Fearon K.C. review.JAMA 2017; 152: 292-298Crossref (1243) Scholar,3Pearsall E.A. Meghji Z. Pitzul K.B. et al.A qualitative study understand the barriers enablers implementing an enhanced program.Ann 2015; 261: 92-96Crossref (127) This makes it difficult for successful experience team extend other around hospital. In 2016, we conducted comprehensive, systematic root cause analysis our hospital (Supplementary Fig. S1) identified main all procedures, including general resistance change, poor communication, collaboration, coordination between lack time staff S2). Notably, realised that unified leading department coordinated management system were As ‘patient surgery-centred’ is core ERAS, anaesthetists play important roles process various specialties, preoperative assessment, intraoperative management, postoperative pain control,4Memtsoudis S.G. Fiasconaro Soffin E.M. al.Enhanced components perioperative outcomes: nationwide observational study.Br Anaesth. 124: 638-647Abstract (28) Scholar,5Moningi S. Patki A. Padhy N. Ramachandran G. anesthesiologist's perspective.J Anaesthesiol Clin Pharmacol. 2019; 35: S5-S13PubMed took advantage anaesthesiology as platform department. We established system, establishment working committee (EWC), workflows, innovative models patient education training, information platforms, rounded quality evaluation systems, disease databases. surgery-centred, anaesthesiology-led’ project led most being performed using principles (a large tertiary hospital). The innovations lessons from can be summarised follows. First, EWC was take role coordinating communications promote procedures. Headed by vice president hospital, composed anaesthetists, subspecialists, nursing staff, others. Department Anaesthesiology assigned via ‘one pilot first, then gradually increasing’ method, which urological set pilot, rolled out To better guide standard work regimes workflows developed. shown Figure 1, specialty needed submit its application management. After approval, organised kick-off meeting with team. reviewing society guideline type, discussed inclusion criteria, items professions, culminated protocol based on type. addition, respective job responsibilities technical personnel programme managers clearly specified. During progress project, consistent well-attended meetings regularly interim summary assessment; meanwhile, audited compliance implemented necessary changes improve practice existing problems promoted closed-loop project. publicise projects increase acceptance execution medical workers, patients, families, also training. For instance, transformed principle into educational posters, brochures S3), song video video), made them available doctors patients. Meanwhile, training contents related added curriculum standardised residents, postgraduates, refresher students, undergraduate ensure efficient communication among teams, deployed WeChat groups each specialty. Combined operating room scheduling electronic record timely sharing, scientific throughout whole operation appointment, sequencing, preparation, anaesthesia follow-up. All members could update prognosis, fed back this platform. mutual surgeons, regular continuous improvement service quality. new normal, Quality Control assessment indicators appropriately linked performance staff. A database enrol patients whose carried specialties. analysed data several ways. Firstly, case reports discussion arranged exceptional cases typical cases. Secondly, dozens prospective retrospective trials explore efficiency surgeries. end 2020, almost have joined anaesthesiology, 30 000 benefited programme, recovery, higher satisfaction, fewer complications, shorter stay, lower cost.6Pan J. Hei Li L. al.The acute during elective cesarean delivery: randomized controlled trial.Ther Risk Manag. 16: 369-378Crossref (5) Scholar, 7Tan J.Q. Chen Y.B. W.H. al.Application period tympanoplasty mastoidectomy.Ear Nose Throat (145561320928222)Crossref (3) 8Wu Kong W. Zhu Q. al.Improved life endoscopic sinus surgery.Ther 15: 683-688Crossref 9Wu X.F. W.F. protocols functional chronic rhinosinusitis nasal polyps: trial.Chin Med (Engl). 132: 253-258Crossref (11) strategy initiated Chinese hospitals proved promoting programmes. Through appointing leader subspecialty, formulating subspecialty organising frequent reports, summaries, four highlights S4). Being central department, unique advantages unified, orderly, manner. approach facilitate rapid dissemination protocols. Our might highly instructive overcoming challenging so far. thank Yang Qintai, Third Affiliated Hospital Sun Yat-Sen University, careful professional suggestions improved manuscript. authors declare they no conflicts interest. Postdoctoral Science Foundation China (Grant No. 2020T130148ZX ).