Author(s): Rebecca Jablonski, MSN, RN, CPAN, CNL
Enhanced Recovery After Surgery Clinical Nurse Leader
Spartanburg Regional Healthcare System

Miles Lane
Quality Data Scientist
Spartanburg Regional Healthcare System

Competency Domain: Performance & Process Improvement

Description: When implementing Enhanced Recovery After Surgery (ERAS) programs, encouraging adherence to process metrics through the care continuum can improve results. Medical literature supports the relationship between higher component adherence and reduced lengths of stay and complication rates. A South Carolina health system adopted ERAS protocols for numerous surgeries and created monitoring tools to track process metrics and outcomes. Using these tools, will an increase in ERAS component adherence rate result in reduced length of stay and complication rates? Demonstrating the importance of individual contributions of team members to obtain high adherence rates can assist in improving individual ERAS component adoption. Problem:We were tasked with standardizing surgical preoperative, intraoperative, and postoperative care in order to decrease length of stay, control readmission rates, and decrease hospital bed utilization. Measurement:We used control charts to represent compliance rates and outcomes such as length of stay and readmission rates over time. Analysis:We exported data out of Epic using Slicer Dicer and Epic dashboard functionality defined to track ERAS cases to retrieve compliance data and other elements. Statistical analysis and visualization are done with the R programming language. Implementation:We set compliance standards using order sets for ERAS service lines from benchmarked institutions and provider consensus. Obstacles encountered were slow adoption and stakeholder resistance. These obstacles were addressed by presenting benchmarked and internal data to support adoption. A coordinated approach and sharing early successes worked best for ERAS implementation. Results/DiscussionBy encouraging high compliance for ERAS order set elements, we observed a significantly lower average length of stay for ERAS surgical cases. We used control charts shared at regular intervals and praised high performers when meeting or exceeding goals. Continually sharing process and outcome metrics are critical to sustaining results.