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BackgroundThe COVID-19 pandemic has exacerbated the backlog of elective surgeries across the National Health Service (NHS). This is particularly critical for patients awaiting cardiac surgery, where even short delays can lead to disease progression and increased risk of complications. Enhanced Recovery After Surgery (ERAS) programmes aim to optimise recovery and reduce length of stay, yet their implementation in cardiac surgery remains inconsistent. This quality improvement project sought to improve the implementation of postoperative ERAS principles to increase the timeliness of recovery and enhance intensive care unit (ICU) capacity.MethodsTime-directed ERAS goals were developed, and a phased educational intervention was implemented through four Plan–Do–Study–Act cycles: (1) introductory teaching and baseline data collection, (2) development of a tool within the electronic patient record to promote real-time implementation of ERAS goals and enable continuous performance monitoring, (3) introduction of an e-learning module and (4) targeted educational interventions. Outcome measures included time to achieve ERAS goals and the proportion of postoperative patients clinically ready for discharge to the ward within 24 and 48 hours. Balancing measures included reintubation and ICU readmission rates.ResultsImplementation of the phased educational intervention led to a sustained reduction in the time required to achieve ERAS goals. The proportion of patients clinically ready for discharge to the ward within 24 and 48 hours increased by 15.6% and 18.0%, respectively, exceeding the project’s 5% target. No increase in reintubation or ICU readmission rates was observed, indicating that improvements were achieved safely.ConclusionsImplementing time-directed ERAS goals through a phased educational intervention increased the timeliness of post-operative recovery after cardiac surgery. This approach has the potential to improve patient flow, enhance ICU capacity and support wider efforts to address elective cardiac surgery backlogs across the NHS.

The rationale: Retromaxillary lesions pose diagnostic and treatment delays due to their location. With classical methods posing great morbidity, advances like Peizotome and microscope-assisted surgeries have gained relevance for efficient management with lesser complications and faster postoperative recovery. Case: A 65-year-old male patient presents with complaints of pain and blurring of the right eye for 10 days. Diagnosis: Clinical and radiological evaluation revealed right eye proptosis with a slow-growing retromaxillary infratemporal tumor with a likely diagnosis of trigeminal schwannoma. Treatment: Surgical management was aided by a piezo-assisted transantral approach for microscope-enabled debulking of the tumor. Outcomes: The final histopathological diagnosis was of schwannoma with the patient having a good postsurgical recovery. Takeaway lesson: Peizotome-assisted transmaxillary approach for microscopic excision of retromaxillary lesions can be considered as a surgical marvel which combines two varied modes of treatment for better patient outcomes.