Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital

Abstract

Background: In March 2016, an Enhanced Recovery After Surgery (ERAS) initiative was implemented for all elective colorectal resections at an urban hospital in St. John's, Newfoundland and Labrador, Canada. An ERAS coordinator supervised and enforced guideline compliance for 6 months. The aim of this study was to evaluate the sustainability of the ERAS program after supervision of guideline compliance was eliminated. Methods: Patient outcomes and guideline compliance were compared between surgeries performed under standard practice (April 2014 to March 2015) and those performed during and after the implementation of the ERAS initiative (March 2016 to August 2016 was the implementation phase and September 2016 to February 2017 was the sustainability phase). Results: Hospital length of stay decreased from 7.26 days at baseline to 5.44 days during the implementation phase of the ERAS program (p < 0.001). There was no significant difference between length of stay at baseline and during the 6-month sustainability phase of the ERAS program (7.10 d). There were no significant differences in rates of readmission or mortality during and after implementation. Rate of ileus decreased significantly from 13.8% during the implementation phase to 4.6% during the sustainability phase (p = 0.036). Total guideline compliance increased from 52.2% at baseline to 80.7% during the implementation phase (p < 0.001), and decreased to 74.7% during the sustainability phase (p < 0.001). Adherence to postoperative guidelines regressed: 79.2% in the implementation phase and 68.6% in the sustainability phase (p < 0.001). Conclusion: Hospital length of stay decreased when the ERAS program was implemented and the ERAS coordinator was present on the surgical ward. Methods for sustaining guideline implementation are vital to the success of similar programs in the future. Contexte : En mars 2016, une initiative de récupération améliorée après la chirurgie (RAAC) a été mise en place pour toutes les résections colorectales électives effectuées dans un hôpital

Lessons following implementation of a colorectal enhanced recovery after surgery (ERAS) protocol in a rural hospital setting

“…This trend has also been demonstrated in the NZ context, where patients undergoing elective colorectal surgery managed within an ERAS pathway had shorter hospital stays without increased morbidity or mortality 24 . However, post‐operative LOS at our institution was longer than contemporary LOS figures quoted by recent studies which range from 3 to 5 days 7,25–29 . This finding could reflect the rurality of our hospital; patients living up to 4 h away from the hospital, and our poor compliance in some of the ERAS protocol components.…”

“…24 However, post-operative LOS at our institution was longer than contemporary LOS figures quoted by recent studies which range from 3 to 5 days. 7,[25][26][27][28][29] This finding could reflect the rurality of our hospital; patients living up to 4 h away from the hospital, and our poor compliance in some of the ERAS protocol components.…”

The Global States and Hotspots of ERAS Research From 2000 to 2020: A Bibliometric and Visualized Study

“…We hypothesize that these results were related to the increasing number of obesity, the aged tendency of the population, and the rising morbidity of malignancies. Barriers during the implementation of ERAS were multifactorial, not only from patients but from managers and practitioners (36). Recently, more studies focused on compliance or adherence to ERAS, sustainability of ERAS in community hospitals, and quality improvement programs (36)(37)(38)(39).…”

“…Barriers during the implementation of ERAS were multifactorial, not only from patients but from managers and practitioners (36). Recently, more studies focused on compliance or adherence to ERAS, sustainability of ERAS in community hospitals, and quality improvement programs (36)(37)(38)(39).…”

Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review

“…19 These challenges highlight the importance of addressing EBI sustainability to reduce implementation waste, to ensure the provision of equitable healthcare and to accelerate impact on patient outcomes. 20 Some empirical research has been published on the sustainability of ERAS in colorectal surgery 21,22 ; however to date, there has been no synthesis or consolidation of the available evidence on ERAS sustainability. Synthesising the current evidence base on the sustainability of ERAS will provide important insights to inform future implementation of ERAS and facilitate ERAS sustainability for continued benefits for patients and health systems, justifying its continued investment.…”