EP556 - The Team Effect: Improving Established Enhanced Recovery For Colorectal Surgery

Purpose/Background: Hospitals have variable success with implementing enhanced recovery protocols (ERPs). We hypothesized that creating a multidisciplinary ERP team would improve compliance and patient outcomes.

Methods/Interventions: A multidisciplinary ERP team was formed and tasked with updating colorectal ERPs, which had previously been in place for 10 years. The team included surgeons, nurses, anesthesiologists, dietitians, pharmacists, and patient educators. Members were invited to join via an email invitation, and their participation was voluntary. The team met monthly to align preoperative and postoperative order sets with current best practices. An intraoperative intravenous fluid (IVF) algorithm was developed to optimize fluid management during surgery. To actively engage patients in their care, the team designed preoperative checklists with dietary instructions and bowel preparation protocols. Via retrospective review of their electronic health records (EHRs), outcomes of all patients who underwent colorectal surgery in 3 eras were compared: (1) 4.5 years pre-ERP team formation (pre-Team); (2) 11 months after ERP team formation and during protocol refinement (Transition); and (3) 10 months after implementation of the updated ERP with ERP team monitoring (post-Team). Outcomes compared were nasogastric tube (NGT) and nil per os (NPO) status, total IVF use, length of stay (LOS), and postoperative complications.

Results/Outcomes: The outcomes of 456 pre-Team, 89 Transition, and 92 post-Team patients were captured from their EHRs (Table 1). Prolonged NPO and/or NGT use occurred for 18% pre-Team, 6.7% during Transition, and 11% post-Team (P=.008). Average total IVF decreased over time (10.3L pre-Team, 6.3L Transition, 6.3L post-Team; P<.001). No significant differences within 30 days after surgery were observed regarding acute kidney injury (P=.051), pressor requirement (P=.3), surgical site infection (P=.9), or readmission (P=.7).

Conclusion/Discussion: Patient outcomes improved following the establishment of an ERP team. Notably, improvements in patient outcomes were observed even before the full implementation of the updated ERP protocol. This suggests that multidisciplinary collaboration itself contributed to this result. Recommending multidisciplinary teams for established ERPs may be high yield for sustainability and integration of protocol improvements across the care continuum.

Table 1. Postoperative Outcomes Over Time
Data are presented as no. of patients (%) unless otherwise indicated. Abbreviations: IVF, intravenous fluid; LOS, length of stay; NPO/NGT, nil per os/nasogastric tube; SD, standard deviation.