Incorporating enhanced recovery after surgery (ERAS) components into an existing elective colorectal clinical pathway leads to improved adherence to eras protocols

Abstract

Objectives: ERAS program is an established multimodal perioperative care approach that has become the standard in elective colorectal surgery. In March 2016, Tan Tock Seng Hospital adopted ERAS protocols for elective colorectal surgery, however participation and compliance to the ERAS protocols were low. Another huge challenge faced was the collection and management of data due to manpower constraints. Our aim was to incorporate the key evidence-based ERAS components into our existing Elective Colorectal Clinical Pathway with the main aim of improving compliance. Our secondary aim was to develop a workflow to facilitate ERAS data management. Methods: In July 2016, a multidisciplinary project team was formed. The team identified key ERAS elements and incorporated them into our existing Elective Colorectal Clinical Pathway. A revised Colorectal Clinical Pathway was piloted for 3 months and implemented in November 2016. Brainstorming and root cause analysis were carried out to identify challenges and possible solutions for ERAS data management. The team streamlined the role of different stakeholders and developed a workflow for data management. A comparison of pre and post-implementation of revised Elective Colorectal Clinical Pathway on 23 ERAS compliance measures and clinical outcomes were carried out during the period of March to October 2016 (n=135) and Nov 2016 to July 2017(n=157). Results: Overall, 70% (16 out of 23) of ERAS compliance measures showed improvement. 91% (10 out of 11) of post-operative ERAS compliance measures showed improvement with the highest improvement rate of 36% for mobilization on Post-operative Day 2. Patients recovered faster with decreased median length of stay (from 7 to 6 days), complications rate (from 47.4% to 39.5%) and 30 days readmission rate (from 7.2% to 5.2%). Data completeness increased from 70% to 97.6% for overall ERAS hospital compliance measures. Conclusion: Incorporating ERAS protocols into existing Colorectal Clinical Pathway successfully improved adherence to the standardized multimodal ERAS protocols and clinical outcomes following colorectal surgery. Role and workflow redesign facilitated data management. Disclosure of Interest: None declared.