A colorectal surgery clinical redesign team recently implemented a best practice known as Enhanced Recovery After Surgery (ERAS) at Yale New Haven Hospital.
Over the past few years, enhanced recovery protocols have demonstrated faster recovery, decreased complications and reduced length of stay after surgery. This, in turn, has produced benefits for patients, increased quality of care, reduced readmissions and decreased costs for hospitals.
The 90-day clinical redesign project team included peri-operative nurses, anesthesiologists, surgeons, internists and staff from quality, nutrition, physical therapy, Information Technology Services and OR schedulers. They examined ERAS guidelines in use at other institutions as a reference and created a comprehensive workflow that standardized care before, during and after surgery. Primarily, ERAS standardizes perioperative care in terms of reduced fasting before and after surgery, medications and encouraging early post-operative ambulation.
Epic was a major support tool for ERAS, with special order sets and fields to standardize documentation and measure 17 ERAS metrics. These metrics include patient education, preoperative carbohydrate loading, anti-nausea medication and pain control, IV fluids, managing patients’ body temperature, limited post-operative fasting, chewing gum to promote return of bowel function, Foley catheter removal and early ambulation.
“I was impressed by the multidisciplinary interest and efforts which allowed us to go from concept to implementation of essential processes over a short period of time,” said Kevin M. Shuster, MD, clinical redesign clinical leader and associate professor of Surgery. “We anticipate outcome measures to produce fewer complications, improved patient satisfaction and decreased length of stay. At the 90-day post-implementation mark, the team has expanded the roll-out to the Saint Raphael Campus and continues to review issues and create solutions.”
YNHH performed its first colon ERAS case in May, followed by ERAS implementation by other teams in gynecologic surgery and urologic surgery. Bridgeport and Greenwich hospitals have also been enthusiastically and successfully implementing ERAS with different types of surgery.
