Ready to Go Home? Patients’ Experiences of the Discharge Process in an Enhanced Recovery After Surgery (ERAS) Program for Colorectal Surgery

Jones, D. Gwynne; Musselman, Reilly; Pearsall, Emily; McKenzie, Marg; Huang, Harden; McLeod, Robin S.

doi:10.1007/s11605-017-3573-0

Cited by 43 publications

(40 citation statements)

References 15 publications

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“…Traditional ERAS discharge criteria have strong emphasis on functional recovery metrics such as independent mobilisation, resuming oral intake and pain control with adequate analgesia. These discharge criteria could be modified to incorporate checking and correcting anaemia before discharge as this enhances functional recovery and the overall patient experience [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of anaemia at discharge following colorectal cancer surgery

Dru

Curtis

Court

et al. 2020

Int J Colorectal Dis

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Objectives Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. Methods A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. Results A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0–200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5–11] vs. 6 [5–8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04–2.5), p = 0.034). Conclusion Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.

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Section: Discussionmentioning

confidence: 99%

Impact of anaemia at discharge following colorectal cancer surgery

Dru

Curtis

Court

et al. 2020

Int J Colorectal Dis

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“…One study investigating factors associated with early discharge of patients with GC undergoing gastrectomy found that several factors, such as improved PA, laboratory variables, minimally invasive surgery, and body temperature, could predict early discharge [43]. For the patients undergoing surgical procedures other than gastrectomy, the reports also supported the relationship between improved PA and early discharge [44,45]. Our study suggested that the surgical staff should regard PA as an important clinical parameter, which has previously been long ignored as research is often hindered by the challenge of adapting an easy, valid, and reliable measure to record PA [6].…”

Section: Discussionmentioning

confidence: 99%

Wearable-Based Mobile Health App in Gastric Cancer Patients for Postoperative Physical Activity Monitoring: Focus Group Study

Wu¹,

Ho²,

Chang³

et al. 2019

JMIR Mhealth Uhealth

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Background Surgical cancer patients often have deteriorated physical activity (PA), which in turn, contributes to poor outcomes and early recurrence of cancer. Mobile health (mHealth) platforms are progressively used for monitoring clinical conditions in medical subjects. Despite prevalent enthusiasm for the use of mHealth, limited studies have applied these platforms to surgical patients who are in much need of care because of acutely significant loss of physical function during the postoperative period. Objective The aim of our study was to determine the feasibility and clinical value of using 1 wearable device connected with the mHealth platform to record PA among patients with gastric cancer (GC) who had undergone gastrectomy. Methods We enrolled surgical GC patients during their inpatient stay and trained them to use the app and wearable device, enabling them to automatically monitor their walking steps. The patients continued to transmit data until postoperative day 28. The primary aim of this study was to validate the feasibility of this system, which was defined as the proportion of participants using each element of the system (wearing the device and uploading step counts) for at least 70% of the 28-day study. “Definitely feasible,” “possibly feasible,” and “not feasible” were defined as ≥70%, 50%-69%, and <50% of participants meeting the criteria, respectively. Moreover, the secondary aim was to evaluate the clinical value of measuring walking steps by examining whether they were associated with early discharge (length of hospital stay <9 days). Results We enrolled 43 GC inpatients for the analysis. The weekly submission rate at the first, second, third, and fourth week was 100%, 93%, 91%, and 86%, respectively. The overall daily submission rate was 95.5% (1150 days, with 43 subjects submitting data for 28 days). These data showed that this system met the definition of “definitely feasible.” Of the 54 missed transmission days, 6 occurred in week 2, 12 occurred in week 3, and 36 occurred in week 4. The primary reason for not sending data was that patients or caregivers forgot to charge the wearable devices (>90%). Furthermore, we used a multivariable-adjusted model to predict early discharge, which demonstrated that every 1000-step increment of walking on postoperative day 5 was associated with early discharge (odds ratio 2.72, 95% CI 1.17-6.32; P =.02). Conclusions Incorporating the use of mobile phone apps with wearable devices to record PA in patients of postoperative GC was feasible in patients undergoing gastrectomy in this study. With the support of the mHealth platform, this app offers seamless tracing of patients’ recovery with a little extra burden and turns subjective PA into an objective, measurable parameter.

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“…2 In addition, the push to decrease length of stay has led to more complex discharge instructions. 3 This makes comprehension of discharge instructions vital to patients' ability to adhere to medical recommendations and correlates directly with patient-reported outcomes. 4 Cumulatively, these responsibilities represent a substantial challenge for physicians.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a mobile app for trauma education: results from a multicenter study

Childs

Breslin

Nguyen

et al. 2020

Trauma Surg Acute Care Open

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BackgroundIn an era of shared decision making, patient expectations for education have increased. Ideal resources would offer accurate information, digital delivery and interaction. Mobile applications have potential to fulfill these requirements. The purpose of this study was to demonstrate adoption of a patient education application (app: http://bit.ly/traumaapp) at multiple sites with disparate locations and varied populations.MethodsA trauma patient education application was developed at one trauma center and subsequently released at three new trauma centers. The app contains information regarding treatment and recovery and was customized with provider information for each institution. Each center was provided with promotional materials, and each had strategies to inform providers and patients about the app. Data regarding utilization was collected. Patients were surveyed about usage and recommendations.ResultsOver the 16-month study period, the app was downloaded 844 times (70%) in the metropolitan regions of the study centers. The three new centers had 380, 89 and 31 downloads, while the original center had 93 downloads. 36% of sessions were greater than 2 min, while 41% were less than a few seconds. The percentage of those surveyed who used the app ranged from 14.3% to 44.0% for a weighted average of 36.8% of those having used the app. The mean patient willingness to recommend the app was 3.3 on a 5-point Likert scale. However, the distribution was bimodal: 60% of patients rated the app 4 or 5, while 32% rated it 1 or 2.DiscussionThe adoption of a trauma patient education app was successful at four centers with disparate patient populations. The majority of patients were likely to recommend the app. Variations in implementation strategies resulted in different rates of download. Integration of the app into patient education by providers is associated with more downloads.Level of evidenceLevel III care management.

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Ready to Go Home? Patients’ Experiences of the Discharge Process in an Enhanced Recovery After Surgery (ERAS) Program for Colorectal Surgery

Abstract: Improved post-operative education for surgical patients prior to discharge within iERAS is required to facilitate patient-centered discharge planning. Such interventions may help decrease unplanned hospital visits during the immediate post-discharge period.

Cited by 43 publications

References 15 publications

Impact of anaemia at discharge following colorectal cancer surgery

Impact of anaemia at discharge following colorectal cancer surgery

Wearable-Based Mobile Health App in Gastric Cancer Patients for Postoperative Physical Activity Monitoring: Focus Group Study

Implementation of a mobile app for trauma education: results from a multicenter study

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