{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T06:10:26Z","timestamp":1763705426260,"version":"build-2065373602"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,3,26]],"date-time":"2018-03-26T00:00:00Z","timestamp":1522022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    The United States Navy uses a visual feedback system for pilots, named \u2018the Greenie Board\u2019, to improve flight manoeuvres on aircraft carriers. Given that increased compliance with enhanced recovery after surgery protocols reduces postoperative complications, we decided to apply a similar feedback system to our institutional enhanced recovery programme. We undertook a prospective 12\u2010month audit of 194 patients assigned to our enhanced recovery programme and evaluated adherence to the anaesthesia\u2010related components of our protocol, before and after implementing a Greenie Board. A compliance score was calculated by summing points for adherence to: intra\u2010operative antibiotic prophylaxis; temperature management; goal\u2010directed intravenous fluid therapy; postoperative nausea and vomiting prophylaxis; and postoperative fluid restriction. The score for each patient was then colour\u2010coded and anonymously displayed for each anaesthetist on a Greenie Board within the operating theatre suite. Protocol adherence improved significantly following introduction, with \u2018Green\u2019 scores (acceptable compliance) increasing from 33% to 72% of patients (p &lt; 0.0001). The greatest improvement was seen with anti\u2010emetic prophylaxis (49% to 70%, p = 0.004) with a consequent reduction in postoperative nausea and vomiting (\n                    <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                    0.42, 95% CI 0.19\u20130.88, p = 0.021). We did not observe a decrease in other postoperative complications nor hospital length of stay. We conclude that this US Navy\u2010inspired feedback system is an easily implemented, low\u2010cost quality improvement tool that significantly improved adherence to intra\u2010operative components of our enhanced recovery protocol. The system lends itself to global scaling to drive quality improvement in healthcare delivery and would be suited to institutions without electronic medical records, including low\u2010resource countries.\n                  <\/jats:p>","DOI":"10.1111\/anae.14157","type":"journal-article","created":{"date-parts":[[2018,3,27]],"date-time":"2018-03-27T01:28:56Z","timestamp":1522114136000},"page":"692-702","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The enhanced recovery after surgery (ERAS) Greenie Board: a Navy\u2010inspired quality improvement tool"],"prefix":"10.1111","volume":"73","author":[{"given":"A. J.","family":"Smirk","sequence":"first","affiliation":[{"name":"Royal Darwin Hospital Darwin NT Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. J.","family":"Nicholson","sequence":"additional","affiliation":[{"name":"The Alfred Hospital Melbourne Vic. Australia"},{"name":"Monash University Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y. L.","family":"Console","sequence":"additional","affiliation":[{"name":"Peter MacCallum Cancer Centre Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. J.","family":"Hunt","sequence":"additional","affiliation":[{"name":"NW Training Scheme Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Herschtal","sequence":"additional","affiliation":[{"name":"Centre for Biostatistics and Clinical Trials Peter MacCallum Cancer Centre Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. N. H. H.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Western Hospital Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Riedel","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics Perioperative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia"},{"name":"Melbourne University Melbourne Vic. 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