ENHANCED RECOVERY PROTOCOL PILOT PROJECT
Issue: Care of the surgical patient is often fragmented, inconsistent, and protocols have not
been updated to follow the most current best practice standards. Multidisciplinary
measures are needed to ensure consistency in the continuum of care for the surgical
patient in order to reduce the risk of adverse events and improve the patient experience.
Efforts are related to successful patient education, staff education, enhanced nutrition and
hydration, effective pain and nausea management, early ambulation, patient satisfaction,
and ileus prevention.
Project Description: Enhanced Recovery Protocol (ERP) is a quality improvement project
which standardizes pre-surgical, intraoperative, and postoperative care in order to
improve patient nutritional and hydration status, decrease complications, shorten length of
stay, and reduce the risk of readmission to the hospital. ERP comprises consistent
management of the general surgical patient through creation of evidence based order sets.
Results: ERP pilot was implemented December 2012. Results as of June 2013 include a
reduction in length of stay from 3.22 to 2.67 days, decrease in readmission rates from 20%
to 10%, and a decreased average total cost of $2119 per case. Patient satisfaction showed a
positive response related to a shortened clear liquid NPO status as well as education and
pain management. The program has been rolled out to other surgical specialties with the
creation and implementation of Urology and Bariatric Surgery Enhanced Recovery
preoperative and postoperative order sets.
Lessons Learned: It takes a team. The multidisciplinary group worked through challenges
which contributed to the success of the program such as point of delivery of nutritional
supplement to the patient, management of costs, description of clear diet and NPO status.
Multimodal methods were incorporated to improve patient outcomes. This is a program
that can be applied to many surgical disciplines. Staff education of all disciplines is needed
initially and continually throughout the organization to maintain the continuum of care.
Administrative support is essential to promote ERP and disseminate practice and
outcomes.
Submitters: Patricia Weisbach, BSN, RN, ONC, CMSRN patricia_weisbach@trihealth.com