PD02-02 ENHANCED RECOVERY AFTER SURGERY AND CARE COORDINATION PATHWAY AT CITY OF HOPE: DECREASED LENGTH OF STAY, READMISSIONS, AND COMPLICATIONS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2016PD02-02 ENHANCED RECOVERY AFTER SURGERY AND CARE COORDINATION PATHWAY AT CITY OF HOPE: DECREASED LENGTH OF STAY, READMISSIONS, AND COMPLICATIONS Steven V. Kardos, M.D. Kevin G. Chan, M.D. Bertram Yuh, M.D. Jonathan Yamzon, M.D. Nora H. Ruel, Finly Zachariah, M.D. Clayton S. Lau, andM.D. Laura CrocittoM.D. Steven V. KardosSteven V. Kardos More articles by this author , Kevin G. ChanKevin G. Chan More articles by this author , Bertram YuhBertram Yuh More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Nora H. RuelNora H. Ruel More articles by this author , Finly ZachariahFinly Zachariah More articles by this author , Clayton S. LauClayton S. Lau More articles by this author , and Laura CrocittoLaura Crocitto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2076AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer is the second most common urologic malignancy with over 73,350 new cases diagnosed annually of which the incidence is increasing in the elderly. Radical cystectomy (RC), the gold standard for muscle invasive disease, carries a particularly high risk of morbidity and mortality, as well as a protracted length of stay (LOS) and increased readmission rates. Furthermore, in 2013, the Institute of Medicine (IOM) declared cancer care in the US a national crisis with a priority to improve quality of care through care coordination. Simultaneously, enhanced recovery after surgery (ERAS) protocols have surfaced as coordinated, evidence-based models designed to standardize medical care, improve outcomes, and lower healthcare costs. At City of Hope (COH), we evaluated our ERAS and care coordination pathway. METHODS In April of 2014, an ERAS and care coordination pathway for bladder cancer was launched at COH with an emphasis on the perioperative care of patients (pts) from a multi-disciplinary team perspective. Preoperatively, pts undergo orientation on stoma education, goals of care, and treatment expectations. The pathway clinically focuses on avoidance of bowel preparation, early feeding and mobilization, minimizing narcotic pain management, and u-opioid antagonists. On discharge, pts are closely monitored via scheduled phone calls as well as clinic visits. Quality metrics including LOS, complications, and readmissions are reported as median and interquartile range (IQR) along with descriptive statistics including chi-square and Wilcoxon rank-sum tests. RESULTS Table 1 illustrates the demographic and clinical characteristics of the cohorts. Since implementation, the median LOS was statistically significant between cohorts with 6 days for pts on pathway compared to 8 days for those preceding the pathway (p=0.0007). Furthermore, the complication and readmission rates have decreased from 67.5% to 50% and from 35% to 30%, respectively. Dehydration and urinary tract infection (UTI) accounted for 17.9% and 21.4% of readmissions for those prior to the pathway, while UTI occurred in 5% of pts readmitted after adhering to the pathway. CONCLUSIONS Our ERAS and care coordination pathway has reduced LOS without an increase in complication nor readmission rates. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e51 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Steven V. Kardos More articles by this author Kevin G. Chan More articles by this author Bertram Yuh More articles by this author Jonathan Yamzon More articles by this author Nora H. Ruel More articles by this author Finly Zachariah More articles by this author Clayton S. Lau More articles by this author Laura Crocitto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...