Development of an Enhanced Recovery After Surgery (ERAS) Patient Kit for the Preoperative Period

Deborah S Keller, MS, MD, Emily Saeler, RN, MSN, CRNI, CNL, Kathy Irish, RN, WOCN, James W Fleshman, MD, FACS, FASCRS, Walter Peters, MD, MBA, FACS, FASCRS. Baylor University Medical Center

Background: To increase patient education, compliance with the preoperative elements of our Enhanced Recovery After Surgery (ERAS) program, and standardize care across practice providers, we sought to develop an Enhanced Recovery After Surgery preoperative patient kit. Our hypothesis was we could develop a cost effective product that could increase compliance and patient satisfaction for continuous quality improvement with our ERAS protocol.

Methods: An institutional multidisciplinary ERAS team developed a consensus on the necessary items for the preoperative surgical period. Items including antibiotics, bowel preparation, body cleansing, carbohydrate loading, and written education were packaged in a custom, branded box. The prototype was tested by patients, physicians, nursing, and ERAS advisory board members for feasibility, convenience, and perception. The feedback on the initial prototype was recorded after presentation to a multidisciplinary team at the institution’s Family Patient Advisory Council.

Results: From the consensus meeting, a 9x9x6in Gables Box with packaging paper branded with the institution’s logo and colors were selected. The box contained Polyethylene Glycol 3350, Metronidazole, Neomycin, CHG Wash, a Gu® Hydration Packet and Energy Gel, our division’s written patient manual for surgery, a 32oz. branded mug, a whimsical stress ball, and brief directions for bowel prep and carbohydrate/ volume loading. The total cost for the ERAS preoperative patient kit was $46.81; total costs of all items separately were $110.91, a patient savings of $64.10. Positive feedback was received on the ease of use, packaging style, practice branding, production and time costs.

Conclusions: In response to a need to increase compliance with ERAS elements and patient satisfaction with the surgical experience, we found an institutional ERAS preoperative patient kit is feasible to create and cost effective for patients undergoing elective surgery. The product is easy to use, well received by patients and care team members, and has the potential to increase compliance of the ERAS protocol for both patients and physicians. Further study is warranted to monitor the impact of the product on patient outcomes once implemented into clinical practice.