Enhanced Recovery After Surgery (ERAS)
for Elective Colon Resection Surgery at
Vancouver General Hospital

Quality Forum 2...
Disclosure Statement
We do not have any affiliation (financial or
otherwise) with a commercial organization
that may have ...
Our Site
Background
• The risk-adjusted reports from the American College of
Surgeons National Surgical Quality Improvement
Program...
True North Goals
Enhanced Recovery After Surgery
Active Patient Involvement
Pre-operative

Intra-operative

Post-operative

•Pre-admission ...
Methods
• A multidisciplinary team (anesthesiologists, surgeons, frontline staff,
organizational leaders and quality impro...
Implementation
February-October 2013

June 2013-Ongoing

 Provided ongoing education for
surgical staff on the ERAS proto...
Progress so far…..
• June-December 2013
 Audited103 cases for intra-operative components

• Compliance 80-100%:
 Normoth...
Progress so far…..
• November-December 2013
 Audited 31 cases for all components

• Compliance 80-100%:
 Pre-admission e...
Mean Length of Stay*
in Post Anesthesia Care Unit (PACU)

*Times patient enters PACU to times when
PACU discharge criteria...
Complications in Post Anesthesia Care Unit
Mean Hospital Length of Stay (days)

7.3

7.2

4.8

October

November

December
Lessons Learned
•
•
•
•

Process mapping
Team building
Communication
Culture of quality and patient safety
Sustainment Plan
•
•
•
•

Continue ongoing education of staff
Continue to engage patients and family
Continue to audit 100...
Acknowledgments
•
•
•
•
•
•

VGH Perioperative Teams
VCH NSQIP Team
ERAS Steering Committee
Numerous Patients and Families...
Contact Information
Andrea Bisaillon, RN BscN
Operations Director - Surgical Services
andrea.bisaillon@vch.ca
Tracey Hong,...
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Reduce Overall Colorectal Morbidity through the Implementation of Enhanced Recovery After Surgery Protocol

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This was presented in session G1 at the Quality Forum 2014 by:

Tracey Hong
Quality & Patient Safety Coordinator, National Surgical Quality Improvment Program
Vancouver Coastal Health

Andrea Bisaillon
Operations Director, Surgical Services
Vancouver Coastal Health

Published in: Health & Medicine
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Reduce Overall Colorectal Morbidity through the Implementation of Enhanced Recovery After Surgery Protocol

  1. 1. Enhanced Recovery After Surgery (ERAS) for Elective Colon Resection Surgery at Vancouver General Hospital Quality Forum 2014
  2. 2. Disclosure Statement We do not have any affiliation (financial or otherwise) with a commercial organization that may have a direct or indirect connection to this initiative or the content of this presentation.
  3. 3. Our Site
  4. 4. Background • The risk-adjusted reports from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) demonstrate that patients at Vancouver General Hospital undergoing colorectal surgery have a high odds ratio of postoperative morbidity (1.50-1.54). o Odds ratio >1.0 indicates hospital is performing worse than expected • Morbidity impacts patients safety and experience, increases length of stay and health care costs.
  5. 5. True North Goals
  6. 6. Enhanced Recovery After Surgery Active Patient Involvement Pre-operative Intra-operative Post-operative •Pre-admission education •Active warming •Early oral nutrition •Early discharge planning •Opioid-sparing technique •Early ambulation •Reduced fasting duration •Surgical techniques •Early catheter removal •Carbohydrate loading •No/selective bowel prep •Venous thromboembolism prophylaxis •Antibiotic prophylaxis •Avoidance of prophylactic NG tubes & drains •Use of chewing gum •Defined discharge criteria •Goal directed peri-operative fluid management •Pain & nausea management •Pre-warming Audit of compliance & outcomes Whole Team Involvement
  7. 7. Methods • A multidisciplinary team (anesthesiologists, surgeons, frontline staff, organizational leaders and quality improvement staff) was formed in February 2013. Goal: • To decrease the morbidity rate for general surgery patients undergoing elective colorectal surgery at Vancouver General Hospital by 50 % by June 2014. Implementation: • The ERAS protocol was implemented in two phases.
  8. 8. Implementation February-October 2013 June 2013-Ongoing  Provided ongoing education for surgical staff on the ERAS protocol Phase 1  Implemented intra-operative components by a core group of anesthesiologists  Developed ERAS documents: o Standardized order sets o Clinical pathway & kardex o Patient teaching booklet o Poster highlighting changes in practice  Audited compliance with intra-operative components  Measured patient outcomes in postanesthesia care unit (PACU) November 2013-Ongoing Phase 2  Implemented pre-operative and post-operative components  Audited compliance with all ERAS components  Measured patient outcomes within 30 days after surgery
  9. 9. Progress so far….. • June-December 2013  Audited103 cases for intra-operative components • Compliance 80-100%:  Normothermia  Prophylaxis antibiotics within 60min of skin cut  Appropriate prophylaxis anti-emetics • Areas of opportunity:  Goal directed fluid management  Antibiotics re-dosing
  10. 10. Progress so far….. • November-December 2013  Audited 31 cases for all components • Compliance 80-100%:  Pre-admission education  Use of chewing gum • Areas of opportunity:     Use of ERAS order set Early mobilization Appropriate use of anti-emetics Appropriate removal of urinary catheter
  11. 11. Mean Length of Stay* in Post Anesthesia Care Unit (PACU) *Times patient enters PACU to times when PACU discharge criteria is met
  12. 12. Complications in Post Anesthesia Care Unit
  13. 13. Mean Hospital Length of Stay (days) 7.3 7.2 4.8 October November December
  14. 14. Lessons Learned • • • • Process mapping Team building Communication Culture of quality and patient safety
  15. 15. Sustainment Plan • • • • Continue ongoing education of staff Continue to engage patients and family Continue to audit 100% of ERAS patients Disseminate audit results to Steering Committee and stakeholders monthly • Celebrate the team’s accomplishments
  16. 16. Acknowledgments • • • • • • VGH Perioperative Teams VCH NSQIP Team ERAS Steering Committee Numerous Patients and Families Stephen Parker: Clinical Nurse Specialist, PHC Deborah Bachand: Projects Manager, Surgical Services, VIHA
  17. 17. Contact Information Andrea Bisaillon, RN BscN Operations Director - Surgical Services andrea.bisaillon@vch.ca Tracey Hong, RN BscN Quality and Patient Safety Coordinator tracey.hong@vch.ca

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