Deborah S Keller, MS, MD, Emily Saeler, MSN, RN, CRNI, CNL, James W Fleshman, MD, FACS, FASCRS, Walter Peters, MD, MBA, FACS, FASCRS. Baylor University Medical Center
Background: Enhanced Recovery After Surgery (ERAS) initiatives are proven to accelerate recovery, improve patient outcomes, and reduce hospital costs. External pressures in the US to decrease cost, length of stay (LOS), and readmissions by implementing changes in payment have emphasized the need for ERAS. While awareness has grown, and tools to guide development of ERAS exist, there is little information on the implementation and audit process. Our goal was to describe the short-term outcomes and obstacles after implementation of a division-wide colorectal ERAS program, and steps devised for improvement.
Methods: A multidisciplinary team developed standardized educational materials and a program comprised of 22 care components spanning preoperative, intraoperative, and postoperative periods for elective colorectal resections. After senior-level buy-in and education for all patient-care team members, the program was implemented at an urban, tertiary-referral center. Prospectively collected data was entered into a divisional database, then analyzed for daily compliance and outcomes. Case analysis was performed to evaluate variables with poor adherence. 30-day outcomes were compared to a matched sample prior to ERAS implementation. Main outcome measures were adherence to ERAS elements and LOS and costs after implementation.
Results: 27 ERAS patients were evaluated in the 1st 30 days. Compared to the matched non-ERAS group, there was a significant decrease in mean LOS (3.70 [SD 1.51] vs. 6.05 [SD 3.92} days; p<0.01) and total direct hospital costs ($10,147 [SD $1,674] vs. $12,603 [SD $4,531]; p<0.01). ERAS patients were adherent to a median 17/22 elements (range, 14-20). Low adherence items (<70%) were preoperative volume/carbohydrate loading, TAP block placement, limited PACU stay, and diet and ambulation on the day of surgery. Adherence was lower for postoperative (78.15%) than preoperative (83.33%) and intraoperative elements (86.57%). To increase compliance, results were broadcast, with LOS and cost reductions highlighted. Teach-back methodology was employed, and processes developed to ensure TAP block placement. Audit reports were created to assess ongoing compliance and guide change management.
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Conclusions: The implementation of ERAS requires multidisciplinary education and compliance for success. Even early in implementation, significant benefits on LOS and costs are realized. Simple processes to identify outcomes and obstacles can facilitate successful change management. As increased adherence to ERAS elements is associated with faster recovery and lower complications, further study to increase adherence is warranted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78887
Program Number: P325
Presentation Session: Poster (Non CME)
Presentation Type: Poster