Study On The Influencing Factors And Implementation Effects Of Enhanced Recovery After Surgery

Objective:In this study,a top-three hospital in Guangzhou was selected as a case hospital,and the medical data related to the three diseases with clear consensus and operational guidelines were extracted,and the effect of ERAS implementation was analyzed in detail.In combination with the specific problems encountered in the implementation of ERAS and the consensus of relevant guidelines,the questionnaire survey method and expert consultation methods are used to explore the specific influencing factors of ERAS promotion practice from the perspective of both doctors and patients,and propose solutions.For the case hospitals and other hospitals of the same level to successfully and effectively implement ERAS,optimize and improve the ERAS implementation plan,improve the medical technology level,ensure medical quality and safety,provide efficient reference for medical resources,and provide hospitals and governments to control medical expenses and Promote grading diagnosis and treatment,and alleviate the problem of unsightly illness and provide new ideas.Methods:1.Literature research method:Through the use of Southern Medical University Library,Guangzhou Library,etc.,access to library resources,use China Knowledge Network(CNKI),Wanfang,PubMed and other literature databases and Internet and other information platforms to understand and learn ERAS,Zhixinxing theoretical model,multidisciplinary The relevant theoretical content knowledge of the diagnosis and treatment model,study the development and application of the above theory in the medical field,and guide the smooth progress of this research,laying a theoretical foundation for this research.2.Expert consultation method:Through consultation and interviews with senior experts such as general surgery,hepatobiliary surgery,orthopedics,obstetrics and gynecology,anesthesiology,nursing department and hospital administrators,investigate and understand the difficulties encountered by ERAS in the case hospital and the benefits of implementing ERAS core measures.At the same time,by consulting the above experts,the questionnaires modified by the study were screened,the content was evaluated rationally,and the research and revision were repeated to determine the questionnaires for both doctors and patients,which greatly protected the medical staff used in this study.The scientific rationality of the ERAS knowledge-based questionnaire and the questionnaire on the cognitive and health participation degree of inpatient medical rehabilitation measures.3.Questionnaire method:This research is based on a large number of literature research foundations and the results of consulting senior experts,combined with the current published ERAS guidelines consensus and operational specifications and ERAS related theory books,using the theory of knowledge lines to carry out preliminary revisions to form"medical personnel accelerated rehabilitation"Surgical(ERAS)Knowledge Line Related Questionnaire and"Inpatients' Questionnaires on Participation and Participation in Medical Nursing Rehabilitation Measures".4.Statistical analysis method:Based on the questionnaire data and the data extracted by the hospital information system,a database was established and statistical analysis was performed using SPSS20.0.Descriptive statistical analysis and independent sample t-test statistical analysis were performed on the collected medical data of the three departments,and detailed statistical analysis was performed on the medical data before and after the implementation of ERAS.The questionnaire data of medical staff and hospitalized patients collected in this study were statistically analyzed by statistical methods such as reliability and validity analysis,one-way ANOVA and multiple linear stepwise regression analysis.The influencing factors of ERAS were studied from the perspective of doctors and patients.P<0.05 was considered statistically significant.5.Knowledge,Attitude/Belief,Practice:This study uses the knowledge and belief theory model to design a questionnaire for the medical staff to accelerate the rehabilitation surgery(ERAS)knowledge and conduct,to study the case hospital medical staff on the ERAS knowledge and attitude behavior and problems encountered in the ERAS promotion practice,in-depth analysis of health care In the process of diagnosis and treatment,personnel practice the influencing factors of accelerated rehabilitation behavior,and ERAS promotes bottleneck problem solutions.Results:1.The three surgical procedures selected in this study were colorectal surgery,cholecystectomy and hip-knee joint replacement.The hospital-related departments have established a standard ERAS with anesthesia as the platform for three surgical procedures.The discipline team,combined with the published guidelines and operational specifications,preliminarily developed and improved the standards and scientific and reasonable standards for the implementation of ERAS core measures for both doctors and patients,and the general surgery has developed a more comprehensive The ERAS order package and assessment of the implementation of ERAS orders during the perioperative period to ensure rapid recovery of patients undergoing colorectal surgery.2.Performing ERAS core measures in strict accordance with ERAS orders can effectively and significantly reduce the total number of hospital stays,total hospitalization costs,and 30-day readmission rates.(1)The total number of hospital stays,total hospitalization expenses,and readmission rate 30 days after surgery were significantly shortened and decreased in patients undergoing colorectal surgery;(2)The total number of hospital stays and total hospitalization expenses were significantly shortened and decreased after operation for cholecystectomy;(3)Total postoperative hospital stay and 30-day readmission rate were significantly shortened and decreased in patients with hip and knee joint replacement surgery.3.Through the questionnaire survey of Zhixinxing,the main factors affecting the practice of ERAS among medical staff are:department,education level,professional title and time of medical work:(1)ERAS knowledge and attitude behavior in anesthesiology and surgery departments is significantly better than other departments;(2)Medical staff with undergraduate and below qualifications,junior professional titles,and medical work for 3 years or less have not yet formed a strong awareness of accelerated rehabilitation.4.The factors found in this survey that mainly affect the cognitive and health participation of inpatients include:age,education,health status,number of hospitalizations,surgical experience,and inpatient departments:(1)The cognitive and health participation of medical treatment for patients over the age of 51 and primary school and below is significantly lower;(2)Hospitalization satisfaction,compliance,and hospitalization mentality were significantly lower in patients who were often ill;(3)Patients with hospitalization experience significantly believe that long-term fasting and indwelling catheters will bring more discomfort,and patients with more than three hospitalizations will not easily change their anxiety after admission.(4)Patients without surgical experience significantly believe that more postoperative rehabilitation measures are beneficial to accelerate recovery;patients with more than 3 surgical experiences have significantly lower satisfaction,but the compliance of getting out of bed as early as possible is significantly higher;(5)The willingness to participate in hepatobiliary surgery was significantly lower;the medical knowledge of orthopaedic inpatients was significantly higher and the hospitalization anxiety was significantly lower.Conclusion:1.The Case Hospital established the ERAS Leading Group and established the ERAS multidisciplinary team.ERAS has achieved remarkable results and strictly adhered to the ERAS medical package process,which can effectively and significantly shorten the number of hospital stays,reduce the total hospitalization cost and the 30-day readmission rate.Guarantee the quality of medical care;2.The ultimate goal of ERAS is to pursue patients with no pain,no stress,no risk and rapid perioperative period.The first task of successfully promoting ERAS is to change the traditional medical care routine,and evaluate the effect of ERAS implementation,with medical services and Medical quality is oriented;3.ERAS also puts forward higher requirements for medical technology level and service level.The promotion of ERAS in medical institultions should be combined with the current development of the unit.The anesthesiology department and the surgical department involved in surgery are the main platforms for the promotion of ERAS,and the complete supporting facilities are formulated.Policy and support from hospital management can greatly promote the development of ERAS;4.Establish ERAS leading group and ERAS multi-disciplinary team to carry out personalized and differentiated comprehensive and detailed health education according to the actual needs of patients,so as to strengthen the awareness of healthy participation of inpatients.Active and healthy participation of patients can promote the reconstruction of doctor-patient relationship.Improve patient satisfaction and compliance,and further ensure medical quality and safety.The innovation of this study:1.Innovatively cut into the research from the perspective of both doctors and patients.This study starts with the analysis of practical problems.For the first time,we take the perspective of both medical staff and patient groups as the starting point.We investigate the knowledge and attitudes of medical staff on accelerating rehabilitation surgery and the patient's awareness and health participation in medical measures.The status quo and dilemma of development and the influencing factors of accelerated rehabilitation surgery.2.The practical application of integrated innovation theory in accelerating the development of rehabilitation surgery.This study observes that integrated innovation theory can play an important role in accelerating the development of rehabilitation surgery and accelerating the multidisciplinary team of rehabilitation surgery and accelerating the implementation of core measures of rehabilitation surgery.3.It is observed for the first time that the concept of accelerated rehabilitation surgery can also be applied outside the field of surgery and the health participation of patients is of great significance for improving the ERAS medical package and accelerating the overall rehabilitation rate of patients during the perioperative period.