Development and implementation of an institutional enhanced recovery program data process

Abstract

Background: With increasing implementation of enhanced recovery programs (ERPs) in clinical practice, standardised data collection and reporting have become critical in addressing the heterogeneity of metrics used for reporting outcomes. Opportunities exist to leverage electronic health record (EHR) systems to collect, analyse, and disseminate ERP data. Objectives: (i) To consolidate relevant ERP variables into a singular data universe; (ii) To create an accessible and intuitive query tool for rapid data retrieval. Method: We reviewed nine established individual team databases to identify common variables to create one standard ERP data dictionary. To address data automation, we used a third-party business intelligence tool to map identified variables within the EHR system, consolidating variables into a single ERP universe. To determine efficacy, we compared times for four experienced research coordinators to use manual, five-universe, and ERP Universe processes to retrieve ERP data for 10 randomly selected surgery patients. Results: The total times to process data variables for all 10 patients for the manual, five universe, and ERP Universe processes were 510, 111, and 76 min, respectively. Shifting from the five-universe or manual process to the ERP Universe resulted in decreases in time of 32% and 85%, respectively. Conclusion: The ERP Universe improves time spent collecting, analysing, and reporting ERP elements without increasing operational costs or interrupting workflow. Implications: Manual data abstraction places significant burden on resources. The creation of a singular instrument dedicated to ERP data abstraction greatly increases the efficiency in which clinicians and supporting staff can query adherence to an ERP protocol.

Evaluating Implementation Costs of an Enhanced Recovery After Surgery (ERAS) Protocol in Colorectal Surgery: A Systematic Review

“…Although a Fisher's exact test did support the trends seen in the literature that ERAS costs overall are lower than those associated with CC, this finding should not be extrapolated The most effective way to standardize ERAS implementation and data reporting among institutions at such a large scale would be to utilize an open electronic database. A standardized ERAS data collection and reporting system called the ERP Universe has recently been developed and implemented successfully across 18 surgical services in MD Anderson [39]. Although the focus of ERP Universe is to collect patient variables regarding their clinical status and postoperative recovery, a similar program may be developed for standardized collection of financial data as well.…”

What defines the “value” of robotic surgery for patients with gastrointestinal cancers? Perspectives from a U.S. Cancer Center

“…MD Anderson has led the evolution of ERAS in various surgical services for the past decade. 84 , 85 , 86 In addition to improved short‐term outcomes and costs, we have reported significant opioid reduction after pancreatectomy and gastrectomy: the majority of patients do not require an opioid prescription at the time of discharge. 85 , 87 …”

“…MD Anderson has led the evolution of ERAS in various surgical services for the past decade. [84][85][86] In addition to improved short-term outcomes and costs, we have reported significant opioid reduction after pancreatectomy and gastrectomy: the majority of patients do not require an opioid prescription at the time of discharge. 85,87 MIS has consistently demonstrated a reduction in opioid use across various operations compared to open approaches, as reported in several studies.…”

“…Additionally, the emphasis on opioid reduction by promoting alternative multimodal pain management, aligns with broader efforts to address the opioid crisis by advocating for responsible and evidence‐based pain management practices in healthcare settings. MD Anderson has led the evolution of ERAS in various surgical services for the past decade 84–86 . In addition to improved short‐term outcomes and costs, we have reported significant opioid reduction after pancreatectomy and gastrectomy: the majority of patients do not require an opioid prescription at the time of discharge 85,87 …”

Challenges and successes in implementing an integrated electronic patient record (HIVE) at the Manchester University National Health Service Foundation Trust, England: 1000+ legacy systems, 10 hospitals, one electronic patient record

“…Challenges to achieving better health data quality were data collection, analysis and reporting. Seif et al (2023: 1) leveraged electronic health systems with the aim to consolidate selected variables into one single “data universe” to create an “accessible and intuitive query tool for rapid data retrieval.” Their enhanced recovery program universe increased efficiency across several analytical tasks without adding to costs or interrupting workflows. Recent examples of newly created and innovative systems include a digital clinical information system designed for a forensic unit in Greece to manage the life cycle of forensic data, including new records, assignment to forensic pathologists, reports, multimedia requirements, issuing certificates and legal documents and statistics (Kalochristianakis et al, 2022).…”