Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Melanie Hardin-Pierce

Committee Member

Katie Rogers

Committee Member

Desiree Chappell

Abstract

OBJECTIVE: The purpose of this study is to evaluate the Enhanced Recovery After Surgery (ERAS) pathway utilized at two Norton Healthcare facilities for colorectal and gynecological surgeries. The specific aim is to examine the impact on patient outcomes, clinical effectiveness, and costs.

METHODS: This was a multi-center, pre-post implementation retrospective study of the impact of ERAS pathways on colorectal surgery patients at Norton Audubon Hospital (NAH) and gynecological surgery patients at Norton Women’s and Children's Hospital (NWCH). The sample included 399 patients including patients from both hospitals, pre- and post-ERAS.

RESULTS: The ERAS pathway lead to a significant reduction in length of stay in the colorectal group (pre 7 days, IQR 6-10.75; post 6 days, IQR 4-10). Overall cost savings were not significant in either population. There was a significant reduction in postoperative complications of anemia (3% vs 13%) and ileus (1% vs 9%) in the gynecological specialty. There was significant reduction in time to diet order (1.8 days vs 3.5 days) for the colorectal specialty. ERAS order sets were ordered on 40.4% of the colorectal specialty and 12% of the gynecological specialty.

CONCLUSION: A significant reduction was seen in LOS in the post-ERAS colorectal population. Having an ERAS order set on the chart of the colorectal patient correlated with a reduction in LOS, decreased time to diet order, and time to mobility. ERAS showed a reduction of some postoperative complications. Lack of adherence to ordering and documentation of the pathway was significant and could have impacted results.

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