Enhanced Recovery Protocol: Implementation at a County Institution with Limited Resources

2012 ◽  
Vol 78 (10) ◽  
pp. 1041-1044
Author(s):  
Kais Rona ◽  
J. Choi ◽  
G. Sigle ◽  
S. Kidd ◽  
G. Ault ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Compliance Rate ◽  
Implementation Process ◽  
Care Plan ◽  
Elective Colorectal Surgery ◽  
Resource Limited ◽  
Standard Order ◽  
Common Process ◽  
Enhanced Recovery Protocol

The benefits of an enhanced recovery protocol (ERP) in colorectal surgery have been well described; however, data on the implementation process is minimal, especially in a resource-limited institution. The purpose of this study was to evaluate outcomes during implementation of a physician-driven ERP at a public-funded institution. We retrospectively reviewed all elective colorectal surgery during a transition from standard care to an ERP (implemented via a standard order sheet). Data regarding use of care plan, length of stay (LOS), and rates of postoperative complications and readmission were recorded. One hundred eleven patients were included in the study; however, complete use of the ERP after its introduction occurred in a total of 50 patients for a compliance rate of 60 per cent (95% confidence interval [CI], 49 to 70). Late implementation of ERP diet, analgesics, and activity were the most common process errors. Full application of the ERP reduced mean LOS by 3 days ( P = 0.002), and there was a trend toward decreased postoperative morbidity without an increase in readmission rate ( P = 0.61). Full implementation of an ERP for colorectal surgery faces many challenges in a resource-limited county institution; however, when fully applied, the ERP safely reduced overall LOS, which is important in cost containment.

Successful Implementation of Enhanced Recovery in Elective Colorectal Surgery is Variable and Dependent on the Local Environment

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Chelsea P. Fischer ◽  
Leandra Knapp ◽  
Mark E. Cohen ◽  
Clifford Y. Ko ◽  
Elizabeth C. Wick
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Local Environment ◽  
Successful Implementation ◽  
Elective Colorectal Surgery

The Effect of an Enhanced Recovery Protocol on Colorectal Surgery Patients With Diabetes

2021 ◽  
Vol 257 ◽  
pp. 153-160
Author(s):  
Santino Cua ◽  
Michelle Humeidan ◽  
Eliza W. Beal ◽  
Stacy Brethauer ◽  
Valerie Pervo ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Patients With Diabetes ◽  
Enhanced Recovery Protocol

scholarly journals 129 Compliance with The ERAS Protocol Amongst Colorectal Surgery Junior Doctors at Gloucester Royal Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Brennan
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Intravenous Fluid ◽  
Junior Doctors ◽  
Intravenous Fluids ◽  
Elective Colorectal Surgery ◽  
Royal Hospital ◽  
Elective Surgical Procedures ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) is an evidence-based protocol aiming to expedite recovery following elective surgical procedures. ERAS has shown to reduce the length of hospital stay, complications, readmissions, and costs. The junior doctor’s role in ERAS centres around admission, preoperative nutritional care, and ERAS compliance. This audit aimed to review prescribing of perioperative nutritional drinks (NutriciaPreop© and Fortisips) and intravenous fluids for patients undergoing elective colorectal surgery at Gloucester Royal Hospital. Method An 80% standard was set for this audit. A full audit cycle was completed. Drug and intravenous fluid charts were analysed for correct prescribing of NutriciaPreop© and intravenous fluids pre-operatively, and peri operative Fortisips. Improvement measures included ward posters and education to incoming junior doctors. Results Initial data collection showed that 70% of patients received a correct intravenous fluid prescription pre-operatively. 24% of patients were prescribed NutriciaPreop© and 18% were prescribed Fortisips. During re-auditing intravenous fluids were correctly prescribed in 80% of patients, NutriciaPreop© in 67% of patients and Fortisips in 60%. Conclusions This audit emphasises the importance of good quality inductions for junior doctors and how simple measures improve prescribing of essential peri-operative nutrition. Additionally, the value of multidisciplinary team involvement in junior doctor training has been highlighted.

An Expanded Preoperative Component within an Enhanced Recovery Protocol Improves Outcomes in Colorectal Surgery

2017 ◽  
Vol 83 (8) ◽  
pp. 928-934
Author(s):  
Nathan M. Johnson ◽  
Sandy L. Fogel
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Statistical Significance ◽  
Current Evidence ◽  
P Value ◽  
Postoperative Length ◽  
Enhanced Recovery Protocol ◽  
Recovery Protocols ◽  
Colorectal Procedures

Enhanced Recovery Protocols (ERPs) have been shown to lead to quicker recovery in colorectal surgery, with reduced postoperative length of stay (LOS). ERPs could potentially be improved with an expanded preoperative component reflecting current evidence. We hypothesize that an ERP with an expanded preoperative component will reduce LOS consistent with or exceeding that seen with traditional ERPs. Our ERP was implemented in June of 2014. Data was collected for two full years from July 2014 through June 2016. The protocol was employed in colorectal cases, both elective and emergent. Data from ERP cases were compared with contemporaneous controls that did not go through the ERP. Patients who underwent colorectal procedures and participated in the ERP with the expanded preoperative component had an average LOS of 5.33 days, whereas controls stayed for an average of 7.93 days (P value, <0.01). ERP cases also experienced fewer read-missions and complications, although statistical significance could not be established. The results demonstrate that an ERP with an enhanced preoperative component significantly reduces LOS and potentially decreases the rate of readmissions and total complications.

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