Same-day Discharge after Robotic Hysterectomy for Benign Conditions: Feasibility and Safety.

STUDY OBJECTIVE: To investigate the feasibility and predictive factors for same-day discharge (SDD) after robotic hysterectomy (RH) for benign indications to optimize patient selection by incorporating preoperative, intraoperative, and postoperative variables. DESIGN: A single-center retrospective cohort study. SETTING: Tertiary academic hospital. PATIENTS: Patients undergoing RH for benign indications. INTERVENTIONS: Patients were designated for SDD by implementing enhanced recovery after surgery protocol. MEASUREMENTS AND MAIN RESULTS: The study included 890 patients who underwent RH for benign indications between the years 2016 and 2021. Of these, 618 (69.4%) were discharged the same day and 272 (30.5%) were admitted for overnight stay. Both groups had similar age (46.4 vs 46.2 years), body mass index (28.3 vs 28.9), and indications for surgery. In multivariable logistic regression, factors that were significant for overnight stay were American Society of Anesthesiologists score 3, Charlson comorbidity index, previous laparotomy, and operative time. Other factors such as surgery start time and preoperative hemoglobin levels were not statistically significant. Postoperative outcomes were comparable for both groups with similar readmission and reoperation rates. CONCLUSION: The likelihood of SDD after RH in this cohort after implementing enhanced recovery after surgery protocol was almost 70%, and most of the predictive factors for overnight stay were nonmodifiable. Importantly, both groups had similar outcomes after surgery.

A Competency-Based Orientation (CBO) Protocol Enhances Competency Among Newly Hired Perianesthesia Nurses.

PURPOSE: The purpose of this quality improvement project was to develop a competency-based orientation (CBO) protocol based on the American Society of PeriAnesthesia Nurses Nursing Standards and CBO for perianesthesia nurses. DESIGN: Feasibility study with pre-post survey design. METHODS: A CBO protocol that included nursing care workflows for 11 common surgical cases was developed and used in orienting newly hired perianesthesia nurses. Newly hired nurses completed a pre-post self-assessment on their level of competency in caring for surgical patients. FINDINGS: Using Wilcoxon signed rank test, improved competency was found in all service areas except for pediatric care. CONCLUSIONS: Nursing competency in the perianesthesia area is critical in fulfilling one's role as a nurse. A robust CBO protocol for the perianesthesia nurse is important when integrating an employee into the organization and preparing the nurse for success.

Delphi Study: ASPAN Adult Patient Pain and Comfort Practices.

PURPOSE: The American Society of PeriAnesthesia Nurses (ASPAN) is responsible for establishing evidence-based standards to guide perianesthesia nursing practice. The ASPAN model for evidence-based practice acknowledges the potential for the Delphi technique to identify priorities for perianesthesia research. The purpose of this Delphi study was to generate a consensus on pain and comfort among a panel of experts. DESIGN: ASPAN convened a panel of experts to provide recommendations based on seven categories, this led to the development of a questionnaire to build consensus. METHODS: Survey conducted among panel of experts to obtain consensus. Two survey rounds were completed. FINDINGS: A consensus was obtained reaching a 70% benchmark for an acceptance. CONCLUSIONS: The results found a consensus on topics required for education and competency among perianesthesia nurses including transfer and discharge criteria related to pain and comfort, resources for perianesthesia nurses, policy guidelines, and the management of the special needs of perianesthesia patients.

Enhanced Recovery After Surgery-The Importance of the Perianesthesia Nurse on Program Success.

Continued advancements in perioperative care and anesthesia technology have improved surgical outcomes and accelerated the patient's ability to resume preoperative activities. With the current emphasis on decreased utilization of expensive hospital resources, a shorter length of stay while maintaining patient satisfaction is encouraged for maximum reimbursement. Through the implementation of evidence-based protocols that standardize care and promote patient medical optimization, the surgical stress response, complications, and time spent in the hospital can be reduced. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. After completing this educational article, the reader will be able to recognize the importance of the perianesthesia nurse in implementing an enhanced recovery after surgery program; review the patient benefits of enhanced recovery; and describe the impact of multimodal pain management on patient length of stay and patient mobility.