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Objective: The Commission on Cancer (CoC) recently introduced a quality metric to optimize time between major head and neck surgery and adjuvant treatment (TAT) ≤6 weeks, as TAT delay adversely impacts patient survival. This study evaluates whether enhanced recovery after surgery (ERAS) for this population reduces the rate of postoperative complications, length of stay (LOS), and TAT. Methods: Patients undergoing larynx or oral cavity resection with free flap reconstruction, ERAS, and adjuvant treatment after 2018 were compared to a historical pre‐ERAS cohort. Patients underwent surgery at a single‐institution tertiary referral center for complex head and neck oncology. Differences between groups were compared by chi‐square, Fisher's exact, or Wilcoxon rank‐sum test. TAT >6 weeks was evaluated with univariate and multivariable logistic regression. Results: Thirty‐nine pre‐ERAS patients were compared to 39 ERAS patients. No demographic differences existed between groups. LOS was improved with ERAS (p = 0.005). ERAS patients were discharged to home and returned to their activities of daily living (ADL) earlier (p = 0.004, 0.001). ADL recovery was associated with on‐time TAT ≤42 days on univariate analysis (OR 1.36, 95% CI 1.13–1.63, p = 0.001). TAT delay was less frequent with ERAS (51.3% vs. 69.2%), but this was not significant after multivariable logistic regression (p = 0.11). Conclusion: ERAS decreases LOS and returns advanced head and neck cancer patients to their ADL sooner. Postoperative ADL recovery independently predicts on‐time adjuvant treatment. Still, compliance beyond 50% with the TAT ≤6 weeks CoC quality metric remains a major treatment barrier. [ABSTRACT FROM AUTHOR]

Background: Older adult patients with COVID-19 and delirium experience higher rates of adverse outcomes. Early recognition of at-risk patients and implementation of management strategies improve outcomes, though understanding barriers to acute care nurses implementing these strategies is limited. Purpose: This study's purpose was to understand the experiences of acute care nurses providing care to older adults with COVID-19 and delirium. Experiences explored included assessment, nursing management interventions, and barriers to care. Methods: Purposive sampling to recruit nurses for semistructured focus groups was performed, and thematic analysis was generated by 4 members of the research team. Results: Twenty-one nurses participated in focus groups. Thematic analysis revealed themes of increased patient social isolation, barriers to delirium assessment and prevention, increased staff demands, and stressful work environments. Conclusion: Rich findings reveal the profound impact of the pandemic on assessment for delirium and implementation of strategies for prevention and management in older adult patients. [ABSTRACT FROM AUTHOR]

Has surgical quality improvement reached a plateau? There was a time when surgery was the 'Wild West.' Dogma and individual preference ruled the care of surgical patients--and patients suffered. Although [...], A similar theme unites proposed solutions for stagnant improvement in outcomes and rising health care costs: eliminate unnecessary variation in the care of surgical patients. While large quality-improvement projects like the Americal College of Surgeons National Surgical Quality Improvement Program have historically led to improved patient outcomes at the hospital level, the next step in surgical quality improvement is to eliminate unnecessary variation at the level of the individual surgeon. Critical examination of individualized clinical, financial and patient-reported outcomes--outcome situational awareness--along with peer group comparison will help surgeons to identify variation in patient care. We are piloting an interactive software platform at our institution to provide information on individualized clinical, financial and patient-reported outcomes in real time through automatic data population of a central REDCap database. These individualized data along with peer group comparison allow surgeons to objectively determine areas of potential improvement.

Background: Compliance to the entire Enhanced Recovery after Surgery (ERAS) protocol improves surgical recovery, where higher compliance improves outcomes. However, specific items may predict improved recovery more than others. Studies have evaluated the impact of individual ERAS recommendations though they are either single center, not based in the United States (US), or focus on colorectal procedures only. This study aims to evaluate compliance on surgical outcomes in two large healthcare systems in the US across four surgery types. Methods: Compliance to individual recommendations, limited patient characteristics, and outcomes data from two US ERAS Centers of Excellence (CoE) for hepatectomy, pancreatectomy, radical cystectomy, and head and neck (HN) resections were evaluated. Outcomes included 30‐day Clavien–Dindo≥3, readmission, mortality, and length of stay (LOS). Multivariate regressions were performed as appropriate for the data for each surgery type. Clavien≥3 was included to control for severity of complications, and the CoE variable was force‐retained. Results: A total of 2886 records were analyzed. Controlling for CoE and severity of patient complications, early removal of Foley catheter was associated with significant reductions in LOS in the liver, pancreas, and HN procedures and reductions in complications in the liver and pancreas. Limited use of NG tubes reduced LOS in the pancreas and complications in urology. Oral carbohydrate loading reduced LOS in the pancreas, and patient education reduced mortality in HN patients. Conclusions: This study reports the effect of ERAS compliance on outcomes, by surgery type, in a multi‐institutional US setting. Future studies should validate these findings and consider surgery‐specific predictive models comprised of individual ERAS recommendations in real‐world applications. [ABSTRACT FROM AUTHOR]

Background: Delirium has been associated with poor outcomes in hospitalized older adults. Rates of delirium have increased in the context of coronavirus disease 2019 (COVID-19). Purpose: To explore the prevalence of delirium in older adult patients hospitalized with COVID-19 as well as correlations with age, gender, length of stay (LOS), occurrence of an intensive care unit admission or transfer, and in-hospital mortality in 2 hospitals in the southeast United States. Methods: A retrospective study of 1502 patients admitted between 2020 and 2021 was completed. Results: Older adult patients hospitalized with delirium and COVID-19 demonstrated significantly prolonged LOS (14.1 days vs 7.1 days, P < .0001) and higher rates of in-hospital mortality (33.5% vs 12.8%, P < .0001). Conclusions: Findings of this study add to the growing literature on delirium in hospitalized patients and support the need for future initiatives to create protocols for monitoring and nursing care management of delirium to improve care delivery. [ABSTRACT FROM AUTHOR]

Objective: College students embrace mobile cell phones (MCPs) as a primary communication and entertainment device. The aim of this study was to investigate college students' perceptions toward using mHealth technology to deliver interventions to prevent high-risk drinking and associated consequences. Design/setting: Four focus group interviews were conducted during the spring and fall of 2011 at a large public university in the southeastern United States of America (USA) to collect data on the applicability of mHealth technology to alcohol-prevention programmes. The participants were students currently enrolled in a face-to-face alcohol-prevention programme. Method: Thematic analysis of the content in the transcriptions was used to analyse the focus group responses using a codebook. Results: Four major themes emerged which were: (1) education and usability; (2) Skype capabilities; (3) enhanced social networking; and (4) use for tracking and feedback. All of the participants said they would join an alcohol-intervention programme that incorporated mHealth mobile technology as a primary mode of communication. Conclusions: The positive responses to the use of mobile applications indicate that use of interactive, real-time technology would be valuable to college students. Given the cost of face-to-face delivery of interventions, the findings are encouraging and support further exploration of the application of mHealth technology. Mobile technologies (mHealth) could provide a more effective delivery of alcohol-intervention programmes and increase the accessibility, relevance, and value of alcohol-intervention programmes.

Background: Enhanced Recovery After Surgery (ERAS) programs reduce recovery time, length of stay (LOS), and complications after major surgical procedures. Purpose: We evaluated our 2-year experience with a newly implemented comprehensive ERAS program at a high-volume center after pancreatic surgery. Methods: Outcomes, cost, and compliance metrics were assessed in 215 patients who underwent elective pancreatic surgery (pre-ERAS; n = 99; post-ERAS: n = 116). Mann-Whitney U and χ² tests were used to evaluate continuous and categorical variables. Results: There were significant decreases in LOS and cost in the post-ERAS cohorts. There were significant increases in compliance with ERAS implementation. Postoperative complication, readmission, and survival rates did not increase. Conclusions: Implementation of ERAS at a large-volume hospital may improve compliance and reduce costs and LOS without increasing adverse outcomes. [ABSTRACT FROM AUTHOR]