Enhanced Recovery After Surgery (ERAS) protocols: the impact of enhanced patient perioperative education on patient satisfaction and outcomes in gynecologic oncology practice

Abstract

<h3>Objectives:</h3> Enhanced Recovery After Surgery (ERAS) protocols have been developed for several surgical fields based off the available evidence to improve patient surgical outcomes with shortened recovery to return of baseline function. The ERAS® Society 2019 preoperative guidelines for gynecologic oncology give a "strong" recommendation for written and verbal preoperative patient education with "moderate" data to support this; however, the recommendation remains vague as to how this should be implemented. We hypothesized patient satisfaction related to their disease state, treatment plan, and hospital course would be improved after implementation of a standardized written preoperative education protocol in addition to traditional oral education for patients undergoing laparotomy with the gynecology oncology faculty at the Medical College of Wisconsin. Secondarily, we hypothesized that enhanced patient education preoperatively could positivelyimpact patient length of stay, emergency department admissions, nursing calls, and readmission rates following surgery. <h3>Methods:</h3> Based on the ERAS Society recommendations, our practice initiated a pilot program to improve our perioperative patient education. In collaboration with our clinic nurses, providers and inpatient nursing staff we revised all of our patient perioperative instructions which address the surgical procedure, expectations prior to surgery, expectations during hospital admission and post- operative instructions including activity limitations, pain management, bowel management and issues of concern during recovery from surgery. We obtained Institutional Review Board (IRB) approval. We compared two groups of patients undergoing laparotomy. The Standard Group received the standard patient education: the current oral and written education that had been utilized in the clinic. The Enhanced Group received the enhanced patient education material after all providers and staff had undergone education regarding the changed process. The enhanced patient education process provided consistent written instructions in addition to the oral instructions communicated by the team. In addition, at the time of discharge standardized post-operative instructions were printed and provided to the patient. During July 2019-Dec 2019, 15 patients who underwent standard preoperative instructions were included in the pilot initiative and comprised the Standard Group. During Jan 2020 - June 2020, 17 patients were included in the pilot as the Enhanced Group. All patients included in the pilot completed the EORTC QLQ-INFO 25 validated survey at the time of discharge or at their post-operative visit. <h3>Results:</h3> Patient satisfaction scores, as quantified by items 31-55 of the EORTC QLQ-INFO 25 survey, showed improvement in patient satisfaction with the possible causes of their disease after protocol implementation (p=0.03). There was also a reduction in the number of patient nursing calls following surgery (p=0.035). There was no difference between groups regarding length of stay, emergency department visits or readmission rates. <h3>Conclusions:</h3> Consistent printed and oral perioperative patient education is an effective measure that can positively impact patient satisfaction as well as staff satisfaction (personal communication). Additional ERAS measures may need to be implemented to impact perioperative patient emergency room visits, length of stay and readmission rates.