Evaluating Enhanced Recovery After Surgery Protocol Implementation at a Midwestern Community Hospital

Mohammad Zeina, RN, DNP, CRNA

DNP Nurse Anesthesia

Evaluating Enhanced Recovery After Surgery Protocol Implementation at a Midwestern Community Hospital 

Project Category:  

Project Team: Mohammad Zeina, DNP, CRNA David Cho, DNP, CRNA, Kyle Mieszcak, DNP, CRNA Jennifer Greenwood, CRNA, PhD, Michael Ledina, DNP, CRNA  (Advisor)

Abstract

Background: Serious but preventable post-operative complications continue to be a prevalent problem within the healthcare system. In the recent decades, implementation of multidisciplinary peri-operative protocols, such as Enhanced Recovery After Surgery (ERAS) has demonstrated potential as an effective tool to reduce rates of complication. This paper aims to assess the effects of a recent ERAS, designated Enhanced Recovery Protocol (ERP), protocol implementation on patient outcomes at a specific Midwest community hospital including need for opioid use, time to ambulation, pain, length of hospital stay, readmission rates, and incidences of DVT, surgical infection, and ileus. 

Methods: A retrospective quality improvement design was utilized to compare a pre-ERAS group of patients to a post-ERAS group of patients. One hundred and fifty-five patients were randomly selected from a pool of 343 patients after meeting inclusion criteria. A chart review was performed for each patient to collect data regarding patient characteristics and outcomes. SPSS was utilized to analyze data and identify potential outcome improvements due to ERAS implementation.

Results: The ERAS cohort showed significantly reduced LOS for the nephrectomy and hysterectomy groups, 0.80 days vs. 4 days (p <0.001) and 0.37 days vs. 1.23 days (p=0.09), respectively. Lower opioid use in the first 24 hours was found for the ERAS cohort of the  colectomy, 1.256 MED vs. 10.923 MED (p= 0.002), and hysterectomy groups, 0.34 MED vs. 23.70 MED (p<0.001). Discharge or max pain scores were significantly reduced for the hysterectomy and nephrectomy ERAS cohorts, 6.27 vs 5.13 (p=0.081) and 4.50 vs 2.05, (p=0.001), respectively.

Conclusion: As a growing number of hospitals continue to implement ERAS protocols, the evidence for associated improved patient outcomes continues to accelerate. With potentially significant financial benefits in addition to clinically relevant improvements in patient outcome, all hospitals (including smaller community-based facilities) should be encouraged to adopt ERAS protocols.

Full Manuscript Slide Presentation Video