Enhanced recovery protocol: Implementation at a county institution with limited resources

Kais Rona, J. Choi, G. Sigle, S. Kidd, G. Ault, A. J. Senagore

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6 Scopus citations

Abstract

The benefits of an enhanced recovery protocol (ERP) in colorectal surgery have been well described; however, data on the implementation process is minimal, especially in a resource-limited institution. The purpose of this study was to evaluate outcomes during implementation of a physician-driven ERP at a public-funded institution. We retrospectively reviewed all elective colorectal surgery during a transition from standard care to an ERP (implemented via a standard order sheet). Data regarding use of care plan, length of stay (LOS), and rates of postoperative complications and readmission were recorded. One hundred eleven patients were included in the study; however, complete use of the ERP after its introduction occurred in a total of 50 patients for a compliance rate of 60 per cent (95% confidence interval [CI], 49 to 70). Late implementation of ERP diet, analgesics, and activity were the most common process errors. Full application of the ERP reduced mean LOS by 3 days (P = 0.002), and there was a trend toward decreased postoperative morbidity without an increase in readmission rate (P = 0.61). Full implementation of an ERP for colorectal surgery faces many challenges in a resource-limited county institution; however, when fully applied, the ERP safely reduced overall LOS, which is important in cost containment.

Original languageEnglish (US)
Pages (from-to)1041-1044
Number of pages4
JournalThe American surgeon
Volume78
Issue number10
StatePublished - Oct 2012
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery

Cite this

Rona, K., Choi, J., Sigle, G., Kidd, S., Ault, G., & Senagore, A. J. (2012). Enhanced recovery protocol: Implementation at a county institution with limited resources. The American surgeon, 78(10), 1041-1044.