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Enhanced recovery protocol: implementation at a county institution with limited resources.
1Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, California 90033, USA. rona@usc.edu
The American Surgeon
|October 3, 2012
Summary
Implementing an enhanced recovery protocol (ERP) in colorectal surgery can significantly reduce hospital stays. Full application of the ERP led to a 3-day decrease in length of stay, demonstrating its value in resource-limited settings.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Healthcare Management
Background:
- Enhanced recovery protocols (ERP) are proven beneficial in colorectal surgery.
- Implementation data, especially in resource-limited settings, is scarce.
- Physician-driven protocols offer a structured approach to care.
Purpose of the Study:
- To assess the outcomes of implementing a physician-driven ERP.
- To evaluate the process and challenges of ERP adoption in a public-funded institution.
- To analyze the impact of ERP on length of stay and postoperative complications.
Main Methods:
- Retrospective review of elective colorectal surgery patients during a transition to ERP.
- Data collection on ERP care plan adherence, length of stay (LOS), and complication/readmission rates.
- Analysis of compliance rates and common process errors.
Main Results:
- 60% compliance rate with ERP implementation.
- Late initiation of diet, analgesics, and activity were primary process errors.
- Full ERP application reduced mean LOS by 3 days (P=0.002).
- A trend towards decreased postoperative morbidity was observed without increased readmission rates (P=0.61).
Conclusions:
- Full ERP implementation in resource-limited settings presents challenges.
- When fully applied, ERP safely and effectively reduces LOS in colorectal surgery.
- ERP contributes to cost containment through reduced length of stay.
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