Surgeon champion key to ERAS, PHS adoption

  • Which Is Better in Pediatrics: Enhanced Recovery After Surgery (ERAS) or Perioperative Surgical Home (PSH)?
  • 8-9 a.m. Wednesday
  • West, Room 2002

Enhanced Recovery After Surgery (ERAS) and Perioperative Surgical Home (PSH) models offer important advantages in patient outcomes, satisfaction, length of stay, cost and other measures in both adult and pediatric populations. And while the two models focus on different strategies to improve care, both depend on the same key factor for successful adoption.

“The key to both is surgeon involvement,” said Vidya T. Raman, M.D., Pediatric Anesthesiologist at Nationwide Children’s Hospital and Clinical Associate Professor of Anesthesia at The Ohio State University College of Medicine in Columbus. “We can push all we want in anesthesiology and it will never move beyond our own internal changes unless surgeons are truly vested and driving it forth. If surgeons aren’t spearheading the change, if you don’t have a champion in surgery, neither ERAS nor PSH are going anywhere.”

Vidya T. Raman, M.D., advocates for ERAS and PSH models.

Dr. Raman will moderate an exploration of both models during “Which Is Better in Pediatrics: Enhanced Recovery After Surgery (ERAS) or Perioperative Surgical Home (PSH)?” The discussion features two experts with hands-on experience.

Karen Thomson, M.D., Assistant Professor of Anesthesiology and Critical Care Medicine and of Pediatrics at George Washington School of Medicine & Health Sciences, helped to design and implement a PSH program at Children’s National main hospital in Washington, D.C.  Megan A. Brockel, M.D., Associate Professor of Anesthesiology at the University of Colorado, helped create the ERAS program at Children’s Hospital Colorado.

“We have done both ERAS and PSH at my institution,” Dr. Raman said. “The most important part is your local factors and what name or program your surgeons prefer. Surgeon preference is important because it is the surgeon who brings in the patient and sells them the program. Both pathways really begin in the surgeon’s office, well before the point at which anesthesia gets involved. You have to have surgeons either be willing to advocate or, better yet, be the instigators.”

One way to sidestep surgeons’ perceptions of PSH is to give the program a different name.

“We changed the name of our pediatric PSH to transitional care unit (TCU), which has worked out much better,” Dr. Raman said. “We are using the same order sets designed for pediatric PSH, the same flow processes from anesthesiology’s point of view, but there is much more enthusiasm from the surgeons with the name change. They tell parents we are going to watch their child for a few hours in the TCU and then they can go home. We get a much better buy-in from parents because the surgeons are telling them about it from the very beginning.”

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