Enhanced Recovery After Surgery for Colorectal Patients

Enhanced Recovery After Surgery for Colorectal Patients


[Music] We were identified as a high outlier from
the National Surgical Quality Improvement Project, also known as NSQIP for surgical
site infections. Our surgical site infection rate was above
20% for several years. [Music] We developed an enhanced recovery after surgery program at our hospital in order to address these issues. ERAS encompasses the entire perioperative timeframe, from preoperative, intraoperative and postoperative. All of the ERAS protocols, everything we’re
doing with the new plan of care is in an effort to decrease surgical site infection and speed
up the recovery process so the patients can get home sooner. Preoperatively, one of our most important
components is that all of our patients meet one-on-one with our nurse practitioner in
order to receive appropriate education. It started off with my first visit with Dr.
Munch, who completely mapped everything out, answered questions. And that continued later on both from him
and his nurse practitioner, who is an ostomy specialist. And there was, anytime I needed to know anything,
either one of them was a phone call away. It was great. All of our patients receive oral antibiotics
as part of their bowel prep, which has been shown to specifically reduce surgical site
infections. With the new protocol we have, it’s standardized
to where the antibiotics are administered at a more appropriate time, and allowed to
be completely infused by the time that the surgeon makes incision. Intraoperatively, we irrigate the wound with
an antibiotic solution in order to decrease surgical site infection. So we went about establishing the best practices
for the medications, mainly by digging into the primary literature. We referenced guidelines. We even reached out to experts within our
own clinical institution and just sought their expertise. Postoperatively, we encourage our patients
to ambulate early. I was in for two surgeries, both the resection
and then the reversal surgery. In both cases, I was up and walking the day
after the surgery. And they stressed that. That you’ve got to get up and moving and
it only helps in recovery, and so I, so I was quite willing to do that. Walking in the hallway, not just walking in
the room. We also like to record the amount of feet
that the patient walks, because they need to have a significant distance to make an
impact on their bowel function. Additionally, we allow our patients to have
regular food the day after surgery. We’ve also changed the amount of IV fluid
that the patient’s going to be receiving after surgery, because if they have too many
IV fluids, then it can cause the bowels to slow down. So pain management and opioid prescribing
is of great importance to the patient’s surgical experience. So with that in mind, we wanted to address
pain management by creating a multi-modal analgesic regimen that relied less on opioids and more on foundational agents that are non-opioid-based. Our ERAS protocol has been a success. We’ve noticed a drastic reduction in in
our surgical site infection rate. Where our rate was initially greater than
20%, it’s now consistently less than 10%. Our length of stay has also decreased. The ERAS protocol is definitely the culture
of the floor. We’re to the point where we don’t need
to look at the orders, because we know exactly what every patient should have. We are constantly analyzing patient outcomes
in order to continually tailor the protocol. [Music]


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