ERAS Guidelines 雖有實證醫學背書,但實際的導入與臨床應用往往挑戰既有的思維與標準作業流程。成功的 ERAS 導入除了需要醫療機構系統性的支持之外,也需要第一線醫療人員持續的教與與訓練。ERAS Society透過delphi method取得58名來自11國ERAS各領域的專家學者意見,經過反覆的討論與修正,建立共識於World Journal of Surgery發表了第一篇針對ERAS Training and Implementation Consensus。
針對ERAS教育訓練的課程設計,專家們認為最重要的課題:
針對如何教育ERAS課程,專家們認為最有效的方式:
- Team-based training with a multidisciplinary faculty (96.67%)
- Face-to-face training (93.33%)
- Online modules/e-learning with integrated assessment (76.67%)
- As part of the undergraduate nursing and medical curricula (76.67%)
- Continual audit and feedback should be performed to demonstrate the benefits of teaching methods (73.33%).
針對ERAS的成功導入,專家們認為要最重要的因素為:
針對ERAS的成功導入,專家們認為跨團隊合作最重要的因素為:
- Development of an effective system of feedback (97%)
- Strong leadership and vision (90%)
- Regular scheduled meetings (80%)
- Clearly aligned goals for patient care (80%)
- Collaborative development of ERAS pathways (77%)
針對ERAS的成功導入,專家們認為ERAS leader最重要的因素為:
- They must be passionate and positive about ERAS (97%)
- Locally respected and able to influence clinical and management colleagues (97%).
針對ERAS的成功導入,專家們認為機構端要最重要的因素為:
- Senior management engagement (87%)
- Linking clinical outcomes of ERAS to organizationalobjectives (87%)
- Including a senior manager within the ERAS team (80%)
- Sharing the positive outcomes of ERAS with senior management (77%)
針對ERAS的成功導入,專家們認為ERAS nurse/facilitator最重要的因素為:
- Enthusiastic team members with correct skills, abilities and time for role (86.67%)
- Have clear roles and responsibilities (83.33%)
針對ERAS執行成果的評鑑,專家們認為最需要收集的資料為:
針對ERAS的資料收集,專家們認為最大阻礙與困難為:
- A lack of human resources (4.13)
- A lack of time (4.10)
- Non-automated or inefficient processes (4.00)
針對ERAS的資料收集,專家們認為最佳的執行角色為:
針對ERAS教育訓練學程的效率,專家們認為需要被評核的項目為:
針對ERAS教育訓練的評核,專家們認為最佳的資料收集方式為:
- Prompt feedback from participants after each course (96.67%)
- Follow-up of ‘‘trained’’ centres using faculty feedback (76.67%)
- Feedback provided by faculty using standardized online feedback forms (70.00%)
針對ERAS訓練中心的成功,專家們認為最重要的條件為:
針對成功的ERAS訓練中心,專家們認為機構應該達到的標準為:
- Publication of data (87.10%)
- Scheduled observation visits (77.42%)
- Both attendance and presentation at national or international meetings (74.19%).
論文連結:
Consensus on Training and Implementation of EnhancedRecovery After Surgery: A Delphi Study
Nader K. Francis et. al.
Published 04 January 2018