224 - ERAS: One Small Step for Thoracic Surgery, One Giant Leap for Patient Recovery
Description: Early Impact of Enhanced Recovery after Surgery (ERAS) Implementation Authors/Institution: Margaret Gould, Lisa Cargill, Rebekah Heath, Isabel Emmerick. UMASSMemorial Medical Center Clinical Issues: Significant variations in clinical care and lack of evidence-based and patient-centric models of care are known to negatively impact surgical outcomes particularly for medically complex and elderly patients. Description of Team: The Division of Thoracic Surgery of the University of Massachusetts Medical School/UMass Memorial Health Care in collaboration with a multidisciplinary team comprised of representation from Perioperative area, Nursing units, Critical Care, and medical office/administrative staff for implementation of this novel approach.Preparation and Planning: The team met weekly and developed a comprehensive ERAS clinical pathway for elective lung resections with the scope inclusive of decision for surgery until 30 days from hospital discharge. This new approach required standardizing processes including pre-operative exercise/smoking cessation, perioperative pain control, patient positioning/draping, instrument choice, and comprehensive postoperative care including transition to home instructions.
Assessment: Voluntary anonymous surveys were sent out to patients, and length of hospital stay/readmissions data were collected from the electronic medical record and analyzed comparing the time period from March 1, 2019–August 31, 2019 the time period of implementation of the ERAS pathway, to retrospective baseline data January 2017–December 2018. Inclusion of the partial implementation time period was not analyzed due to the potential variability of data. Data was stratified according to the type of lung resection (sublobar resection versus lobectomy). Implementation: Post implementation multidisciplinary meetings continued to reinforce protocols and collect quality metric data.Outcome: Lobectomies and wedges accounted for 71, 75 and 48 surgical cases for 2017, 2018 and 2019 respectively. The patient profile was similar retrospectively, average age of 62 years, majority were female and white. A significant increase in the percentage of females and non-whites was noted in 2019. Overall there was a reduction in the percentage of readmissions when comparing the pre and post-ERAS implementation periods. The overall length of stay was reduced by one day, which represents a reduction of 25%. 38/48 patients returned surveys regarding their perioperative experience, with >90% agreeing or strongly agreeing with meeting of clinical pathways from the pre-op to discharge experience.Implications for Perioperative Nursing: These early findings suggest a beneficial impact of ERAS to patient outcomes/satisfaction, with protocol implementation. Our goal, with continued monitoring and analyzing of data, is to drive awareness for all Thoracic Perioperative services, plus provide a Spring CEU presentation.
Co-Authors: Rebekah Heath, Lisa Cargill, Isabel Emmerick