Construction and application of enhanced recovery after surgery-optimized management system with nurse-led multidisciplinary cooperation.
Chen Xiaoyan, He Wenbin, Du Li and 7 others
PMID 36855236WHAT IT FOUND
Patients who received a 19-item ERAS bundle had shorter fasting, earlier feeding, lower pain, fewer malnutrition and DVT cases, shorter stay and lower costs than the prior-year control group.
Key findings
01Compared with the control group, the trial group had better ERAS observation indicators, and the differences were statistically significant.
02The trial group had shorter preoperative no-drinking time (3.30 ± 0.86 h vs 8.04 ± 2.30 h), lower pain score (0.88 ± 0.69 vs 3.16 ± 0.80) and shorter postoperative hospitalization time (7.71 ± 1.88 d vs 10.26 ± 3.07 d).
03Nurse professional identity total scores were higher in the trial group than the control group at 3 months (20.54 ± 1.53 vs 16.00 ± 0.95) and 6 months (21.87 ± 1.47 vs 16.01 ± 1.11).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one hospital and used convenience sampling with a historical control group. Differences between 2021 and 2020 patients, staff, cases or hospital conditions may explain the results. The intervention was a 19-item ERAS bundle delivered by a multidisciplinary team. The effect of nurse leadership or any single measure cannot be separated. The paper does not name a primary outcome and reports many positive results. It is difficult to know which finding was the main test. The text says 220 patients were selected in each group, but the analysed tables report 219 control and 221 trial patients. The medical cooperation questionnaire is inconsistently described. The methods say doctors were compared, while the results sentence says nurses were surveyed. The nurse professional identity scale is described as having a total score range of 30 to 150, but the reported total scores include 16.53 ± 1.18 and 21.87 ± 1.47. This mismatch leaves the score meaning unclear. Nurses and doctors could not be blinded. The authors state that professional identity and cooperation satisfaction may be affected by the Hawthorne effect. The study was conducted during the COVID-19 pandemic under epidemic prevention rules. This may have affected care delivery.
Declared interests
The study was funded by Zhongnan Hospital of Wuhan University. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that nurse leadership alone caused the better patient outcomes. The trial group received a 19-item ERAS bundle delivered by a multidisciplinary team, and the study compared 2021 patients with 2020 patients in one hospital, so the contribution of any single component cannot be separated.