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CME: Surgical Quality Improvement - 2015

Activity Description / Statement of Need:

In this online CME self-learning program:


There are a multitude of strategies a healthcare organization may adopt to improve its surgical quality standards, chief among them enhanced recovery pathways (ERPs) or enhanced recovery after surgery (ERAS) practices, which encompass myriad components. These components include a variety of what have traditionally been interspersed into different areas of specialty: antisepsis and infection control, patient warming, glucose control, multimodal pain control, nausea control, fluid and nutrition therapy, and many others, not to mention ensuring that all of these aspects continue uninterrupted while the patient transitions throughout all levels of care. These pathways are designed to attenuate the stress response during a patient’s surgical procedure and preserve organ function while promoting early recovery.  While this approach is not new, it has not always been widely employed in spite of supporting evidence from a range of randomized controlled trials, systematic reviews, and meta-analyses.  This literature suggests that ERAS programs are safe, cost-effective, and minimize the length of stay in a hospital without compromising quality of care. ERAS programs are successful in part because they are proactive in nature, comprised of interventions beginning during preoperative planning and continuing through intraoperative management and postoperative care.


Although the evidence suggests that the multimodal, ERAS approach may be superior to conventional perioperative care, there are a number of challenges to the adoption of ERAS where it is not already used, including: resistance to change, variability between components and compliance to ERAS protocols, and the need for an engaged multidisciplinary team.


Anyone working at in the inpatient healthcare setting at any level who has seen leadership change attempt to make change – whether executed successfully or not – knows that the process is not easy and that it takes a considerable degree of effort and coordination. Dr. Sandy Fogel shares his experience – and success – at Carilion Clinic effecting change at his institution adopting ERPs at the institutional level.


Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

This program is supported by Educational Grants from Edwards Lifesciences.

Release Date: September 12, 2015 -- Expiration Date: September 12, 2017

Faculty: Sandy Fogel, MD


Learning Objectives

By the end of the session the participant will be able to:

  • Recall the historical justification (observations prior to the early 2000s) for the National Surgical Quality Improvement Program as it exists today
  • Describe the impact of the recovery after surgery (ERAS) techniques may have on patient outcomes
  • Synthesize a hypothetical surgical quality improvement program based on the experience of other institutions



Faculty Disclosure and Resolution of COI

 As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved through  content review ScientiaCME.


Faculty Disclosure:

Dr.  Sandy Fogel, MD discloses that he is a consultant / speaker for Edwards Lifesciences.


Disclosures of Educational Planner: Charles Turck, PharmD is an officer and part owner of ScientiaCME, LLC, which has received a grant from the commercial supporter of this program: Edwards Lifesciences .


Commercial Support Disclosure: This program is supported by an educational grant from Edwards Lifesciences 


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.