Barts ERACS
Bart's Enhanced recovery after cardiac surgery progam
Info bulletin Autumn 2024
Barts ERACS
Welcome
Timeline
Goals
Newsflash
Interview with a ...
Zoom on...
Detailed outcomes
Outcomes summary
Please click on a category to access content.
The ERACS programme at Barts is based on 22 recommendations from the ERAS cardiac society, ERACS is different to cardiac fast track as it serves to preoptimise and enhance the care of patients across a range of complexities: It involves the application of multiple evidence based care bundles across the entire perioperative pathway to reduce morbidity outcomes, length of stay, improve patient engagement and experience after cardiac surgery.
Barts ERACS objectives
The ERACS programme is managed by a multi-disciplinary team that reviews processes across the entire perioperative pathway.
The pathway, strategic processes and patient outcomes are under continuous, bi-weekly review by the multidisciplinary ERACS team, supported by service managers and hospital matrons.
- Hospital post surgical LOS: 4 days
'Length Of Stay' goals:
- Extubation: < 3 hours
- Sitting out in chair: Day 0
- Hallway exercises: Day 1
ICU specific goals:
Barts ERACS Timeline
Current
Increasing volume and complexity of patients First outcome assesments
10/2023
20/06/23
1st Patient
treated on ERACS pathway
2019
20/06/24
09/2024
start-up
1st anniversary
Hosting 1st external center training
Pathway approved
by Barts Clinical Practice Group
exploration feasibility of pathway
253 patients sucessfully treated
Latest initiatives
Willkomen,Bienvenue, Welcome
Evaluate, re-evaluate
London Landmarks
ERACS outcomes summary
June 23 - September 24
First floor
Postop hospital
Postop Cardiac ward
Length of stay
3.1 days
27 hrs
LOS ICU
LOS HDU
26 hrs
Length of stay
5.1 days
61 pt
1st floor LOS
41 hrs
Median data from 369 patients
Reasons for prolonged ward stay
Median LOS
3.1 days
Detailed ERACS outcomes
June 23 - September 24
Click on the to reveal and hide outcomes per ward
Hospital LOS & MACCE outcomes
Intensive care
parameters
Procedures
369 patients
patient demographics
Cardiac ward
parameters
Procedures/ month
Patient demographics
Median euroscore: 1
% of patients reaching target
27 hrs
Median length of stay ICU
23 hrs
Median time till chestdrain removal
Median time to sitting out
12.7 hrs
2.5 hrs
Median time to extubation
Median LOS
5.1 days
Zoom in on...
ICU delays
Pacing wire usage
2023 -2024 comparison
Process measurements
Morbidity
Interview with a vampire surgeon
Dr Dincer Aktuerk, Consultant cardiothoracic surgeon
Please click on the question to reveal the answer
How did you get involved in the ERACS program?
Do you think it benefits the patients and if so, how?
Do you see a difference in patient progression and wellbeing between ERACS and non-ERACS patients undergoing similar surgery?
Do you have any suggestions to improve the pathway?
Do you think it benefits the patients and if so, how?
"I absolutely believe that ERACS benefits patients. By facilitating early mobilization and recovery, the program helps to:
- Improve patient satisfaction: Patients often report feeling better and more empowered when they are able to participate actively in their recovery.
- Shorten hospital stays: ERACS can help patients leave the hospital sooner, which can reduce costs and improve their overall quality of life.
- Reduce complications: Early movement can help prevent complications such as pneumonia and blood clots.
Do you see a difference in patient progression and wellbeing between ERACS and non-ERACS patients?
I think patients generally have superior outcomes compared to those undergoing similar surgery without the programme. They tend to have lower complication rates, shorter hospital stays, and higher satisfaction levels. However, it's crucial to acknowledge that our initial ERACS patients were primarily low-risk individuals. It's equally important to ensure that ERACS is effectively implemented for patients with more complex conditions.
Pacing wires placement:
A+ V wires: 236/321 patients (74%) V wires: 58/321 patients (18%) No wires: 27/321 patients (8%)
Pacing wires usage:
A+ V wires: 124/236 patients (52%) V wires: 8/58 patients ( 13%)
CABG: 173pt: 113 AV -> 58 (51%) used 39 V -> 3 ( 7%) used 19 No PW
Valves: 123pt: 108 AV -> 59 (55%) used 15 V -> 6 (40%) used
Process measures: Median time to ...
Extubation
2.5 hrs
347 pt
268 pt
Catheter removal
24 hrs
Mobilising
20hrs
229 pt
Sit in chair
12hrs
298 pt
Drain removal
22.6 hrs
304 pt
Welcome to the autumn edition of the quarterly ERACS Info bulletin,Your source for the latest news and insights in the dynamic field of ERACS at Barts. With this interactive bulletin, we strive to keep you informed about our goals, achievements and evidence-based practices that contribute to the enhancement of patient outcomes. Join us to contribute and to stay informed about the pioneering Enhanced Recovery after Cardiac Surgery program at Barts!
Remind yourself what Barts ERACS stands for!
How did you get involved in eracs
"As a cardiac surgeon, I've been involved in the ERACS programme for several reasons:
2. Evidence-Based Medicine: The ERACS programme is grounded in scientific evidence, which is essential in making informed decisions about patient care. 3. Collaboration: ERACS fosters a collaborative environment among healthcare professionals, which is crucial for ensuring that patients receive the highest quality care.".
1. Patient-Centred Care: ERACS aligns with my commitment to providing the best possible care to my patients. The programme's emphasis on early mobilisation and recovery is a crucial step in improving patient outcomes post cardiac surgery.
Reasons delayed ICU discharge
Organisational 11%
Medical 36%
38/326 patients
116/326 patients
Audit & Qi projects
We are continuously evaluating our ERACS practice, and are performing multiple audits!We are looking at amongst others transfusion data, pacing wires usage, chest drains, Length of stay,... More on this on the coming audit days!
Do you have any suggestions to improve the pathway?
"To make the ERACS pathway even better, we could consider:"
- Conducting further research: Continued research can help to identify new ways to optimise the ERACS pathway and improve patient outcomes.
- To further enhance the patient experience, we will be introducing an app that allows patients to virtually tour our hospital facilities, including the ICU and ward. This feature will provide patients with a sense of familiarity and can help to alleviate anxiety prior to surgery.
- Expanding access: Ensuring that more patients have access to ERACS programmes can help to improve outcomes for a wider population.
- Tailoring the programme: Recognising that individual patients have different needs, we could tailor the ERACS program to meet the specific requirements of each patient.
Walk the London Landmark Loop
To assist in mobilisation on the cardiac surgery ward, the creative minds of the 4A nursing staff created the London Landmark Loop. Patients can stroll from one iconic building to the next, and learning some fun facts at the same time!
ERACS Visitors
Word of our successful ERACS program travels fast and far! At the end of September we hosted a Welsh multidisciplinary team who are eager to start their own ERACS program, and wanted to learn from the experts. More visiting delegations are expected the next few months!
The POM clinical director Dr Martin Lees , explaining the impact of the ERACS program at Barts to our visitors.
Morbidity
Delirium
Painscore >5/10
ICU readmission
SSI
3.3% (12/368)
0.9% (3/329)
3% (10/318)
16.4% (50/305)
stroke
0.3% (3/328)
Transfusion 1st floor
PPM
Resternotomy
PM>6hr
1% (3/329)
41% (132/315)
16% (61/369)
0.2% (8/368)
More frequent more complex similar LOS
2024
2023
VS
Contact
Dr Bonnie Kyle ERACS lead Bonnie.Kyle@nhs.net Dr Katelijne Buyck ERACS education lead Katelijne.buyck@nhs.net Dr Carlos Corredor PACU lead Carlos.corredorrosero@nhs.net
Autumn 2024 ERACS info bulletin
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Created on October 23, 2024
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Transcript
Barts ERACS
Bart's Enhanced recovery after cardiac surgery progam
Info bulletin Autumn 2024
Barts ERACS
Welcome
Timeline
Goals
Newsflash
Interview with a ...
Zoom on...
Detailed outcomes
Outcomes summary
Please click on a category to access content.
The ERACS programme at Barts is based on 22 recommendations from the ERAS cardiac society, ERACS is different to cardiac fast track as it serves to preoptimise and enhance the care of patients across a range of complexities: It involves the application of multiple evidence based care bundles across the entire perioperative pathway to reduce morbidity outcomes, length of stay, improve patient engagement and experience after cardiac surgery.
Barts ERACS objectives
The ERACS programme is managed by a multi-disciplinary team that reviews processes across the entire perioperative pathway.
The pathway, strategic processes and patient outcomes are under continuous, bi-weekly review by the multidisciplinary ERACS team, supported by service managers and hospital matrons.
'Length Of Stay' goals:
ICU specific goals:
Barts ERACS Timeline
Current
Increasing volume and complexity of patients First outcome assesments
10/2023
20/06/23
1st Patient
treated on ERACS pathway
2019
20/06/24
09/2024
start-up
1st anniversary
Hosting 1st external center training
Pathway approved
by Barts Clinical Practice Group
exploration feasibility of pathway
253 patients sucessfully treated
Latest initiatives
Willkomen,Bienvenue, Welcome
Evaluate, re-evaluate
London Landmarks
ERACS outcomes summary
June 23 - September 24
First floor
Postop hospital
Postop Cardiac ward
Length of stay
3.1 days
27 hrs
LOS ICU
LOS HDU
26 hrs
Length of stay
5.1 days
61 pt
1st floor LOS
41 hrs
Median data from 369 patients
Reasons for prolonged ward stay
Median LOS
3.1 days
Detailed ERACS outcomes
June 23 - September 24
Click on the to reveal and hide outcomes per ward
Hospital LOS & MACCE outcomes
Intensive care
parameters
Procedures
369 patients
patient demographics
Cardiac ward
parameters
Procedures/ month
Patient demographics
Median euroscore: 1
% of patients reaching target
27 hrs
Median length of stay ICU
23 hrs
Median time till chestdrain removal
Median time to sitting out
12.7 hrs
2.5 hrs
Median time to extubation
Median LOS
5.1 days
Zoom in on...
ICU delays
Pacing wire usage
2023 -2024 comparison
Process measurements
Morbidity
Interview with a vampire surgeon
Dr Dincer Aktuerk, Consultant cardiothoracic surgeon
Please click on the question to reveal the answer
How did you get involved in the ERACS program?
Do you think it benefits the patients and if so, how?
Do you see a difference in patient progression and wellbeing between ERACS and non-ERACS patients undergoing similar surgery?
Do you have any suggestions to improve the pathway?
Do you think it benefits the patients and if so, how?
"I absolutely believe that ERACS benefits patients. By facilitating early mobilization and recovery, the program helps to:
Do you see a difference in patient progression and wellbeing between ERACS and non-ERACS patients?
I think patients generally have superior outcomes compared to those undergoing similar surgery without the programme. They tend to have lower complication rates, shorter hospital stays, and higher satisfaction levels. However, it's crucial to acknowledge that our initial ERACS patients were primarily low-risk individuals. It's equally important to ensure that ERACS is effectively implemented for patients with more complex conditions.
Pacing wires placement:
A+ V wires: 236/321 patients (74%) V wires: 58/321 patients (18%) No wires: 27/321 patients (8%)
Pacing wires usage:
A+ V wires: 124/236 patients (52%) V wires: 8/58 patients ( 13%)
CABG: 173pt: 113 AV -> 58 (51%) used 39 V -> 3 ( 7%) used 19 No PW
Valves: 123pt: 108 AV -> 59 (55%) used 15 V -> 6 (40%) used
Process measures: Median time to ...
Extubation
2.5 hrs
347 pt
268 pt
Catheter removal
24 hrs
Mobilising
20hrs
229 pt
Sit in chair
12hrs
298 pt
Drain removal
22.6 hrs
304 pt
Welcome to the autumn edition of the quarterly ERACS Info bulletin,Your source for the latest news and insights in the dynamic field of ERACS at Barts. With this interactive bulletin, we strive to keep you informed about our goals, achievements and evidence-based practices that contribute to the enhancement of patient outcomes. Join us to contribute and to stay informed about the pioneering Enhanced Recovery after Cardiac Surgery program at Barts!
Remind yourself what Barts ERACS stands for!
How did you get involved in eracs
"As a cardiac surgeon, I've been involved in the ERACS programme for several reasons:
2. Evidence-Based Medicine: The ERACS programme is grounded in scientific evidence, which is essential in making informed decisions about patient care. 3. Collaboration: ERACS fosters a collaborative environment among healthcare professionals, which is crucial for ensuring that patients receive the highest quality care.".
1. Patient-Centred Care: ERACS aligns with my commitment to providing the best possible care to my patients. The programme's emphasis on early mobilisation and recovery is a crucial step in improving patient outcomes post cardiac surgery.
Reasons delayed ICU discharge
Organisational 11%
Medical 36%
38/326 patients
116/326 patients
Audit & Qi projects
We are continuously evaluating our ERACS practice, and are performing multiple audits!We are looking at amongst others transfusion data, pacing wires usage, chest drains, Length of stay,... More on this on the coming audit days!
Do you have any suggestions to improve the pathway?
"To make the ERACS pathway even better, we could consider:"
Walk the London Landmark Loop
To assist in mobilisation on the cardiac surgery ward, the creative minds of the 4A nursing staff created the London Landmark Loop. Patients can stroll from one iconic building to the next, and learning some fun facts at the same time!
ERACS Visitors
Word of our successful ERACS program travels fast and far! At the end of September we hosted a Welsh multidisciplinary team who are eager to start their own ERACS program, and wanted to learn from the experts. More visiting delegations are expected the next few months!
The POM clinical director Dr Martin Lees , explaining the impact of the ERACS program at Barts to our visitors.
Morbidity
Delirium
Painscore >5/10
ICU readmission
SSI
3.3% (12/368)
0.9% (3/329)
3% (10/318)
16.4% (50/305)
stroke
0.3% (3/328)
Transfusion 1st floor
PPM
Resternotomy
PM>6hr
1% (3/329)
41% (132/315)
16% (61/369)
0.2% (8/368)
More frequent more complex similar LOS
2024
2023
VS
Contact
Dr Bonnie Kyle ERACS lead Bonnie.Kyle@nhs.net Dr Katelijne Buyck ERACS education lead Katelijne.buyck@nhs.net Dr Carlos Corredor PACU lead Carlos.corredorrosero@nhs.net