title: Attitudes, awareness and barriers regarding evidence-based orthopedic surgery between health professionals from a Brazilian Public Health System (SUS) hospital: Study of 400 patients.
abstract: BACKGROUND
  The fast-track concept refers to all phases of perioperative care: Preoperative, intraoperative, and postoperative strategies. Although most research has focused on adherence to medication, adherence also encompasses numerous health-related behaviors. The aim of this prospective study was to determine the attitudes and awareness among health professionals involved in the treatment of elderly patients with fractures of the femur and the results of 400 patients.
  
  
  METHODS
  The postoperative protocol acceleration was presented to various hospital departments through four seminars. Questionnaire with four ex-residents in the Department of Anesthesiology was conducted. Every 6 months, the results of project implementation to all departments were presented. It was considered adherence to the project when the professionals agreed with all the steps and routines of the project. Patients underwent spinal anesthesia with postoperative analgesia by lumbar plexus block.
  
  
  RESULTS
  All departments involved in the treatment of elderly patients' adhered completely to the project and reported the importance of preanesthetic visit, the explanations of design, and reduction of fasting period. Just one anesthetist completely adhered to the project. No former resident of anesthesia joined the program. All parameters studied in 400 patients compared with the data before the project showed a reduction from 21.38% to 100%.
  
  
  CONCLUSIONS
  Improving adherence requires a continuous and dynamic process. We can be inferred that the implementation of fast-track project Brazilian Public Health System (Sistema Único Saúde, SUS) costs decreased with elderly patients with hip fractures. The anesthesiologist was the major obstacle to deployment to all patients.
authors.affiliation: Department of Anesthesiology, School of Medicine Nova Esperança, PB, Brazil; Department of Anesthesiology, Anesthesiologist Complexo Hospitalar Mangabeira, João Pessoa, PB, Brazil.
authors.forename: Luiz Eduardo
authors.initials: LE
authors.lastname: Imbelloni
authors.affiliation: Master in Labour Economics, UFPB, PB, Brazil; Statistician of the Complexo Hospitalar Mangabeira, João Pessoa, PB, Brazil.
authors.forename: Geraldo Borges
authors.initials: GB
authors.lastname: de Morais Filho
keywords: Fasting; fast-track surgery; medical adherence; orthopedic; perioperative care; spinal anesthesia; surgery