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Related Experiment Videos

Optimizing an Enhanced Recovery Pathway Program: Development of a Postimplementation Audit Strategy.

Michael C Grant, Daniel J Galante, Deborah B Hobson

    Joint Commission Journal on Quality and Patient Safety
    |September 26, 2017
    PubMed
    Summary
    This summary is machine-generated.

    Auditing enhanced recovery pathways (ERPs) effectively identifies implementation defects. Focusing audits on patients exceeding expected length of stay (LOS) significantly reduced outliers' LOS, improving care value.

    Related Experiment Videos

    Area of Science:

    • Surgical Care Improvement
    • Healthcare Management
    • Patient Outcomes Research

    Background:

    • Enhanced Recovery Pathways (ERPs) are evidence-based protocols designed to optimize surgical patient care.
    • ERPs aim to reduce harm, shorten length of stay (LOS), and improve overall healthcare value.
    • A systematic auditing procedure was developed to evaluate compliance with 18 ERP process measures.

    Purpose of the Study:

    • To assess the effectiveness of an auditing procedure in identifying and addressing defects in ERP implementation.
    • To evaluate the impact of system-level interventions on ERP compliance and patient LOS.
    • To determine if targeted audits improve patient outcomes within ERPs.

    Main Methods:

    • A one-year audit of 413 colorectal surgery patients on an ERP at an academic medical center.
    • Patients were stratified into 'successes' (met expected LOS) and 'outliers' (exceeded historical LOS).
    • System-level interventions were implemented based on audit findings, with a three-month follow-up assessment.

    Main Results:

    • Detailed review of outliers identified specific defects, with improvements noted after system-level changes (e.g., early mobility: 44.4% vs. 59.5%, p=0.02).
    • Overall LOS did not significantly decrease (5.2±5.0 vs. 4.9±3.0 days, p=0.37) despite improved compliance.
    • The audit procedure significantly reduced outliers' LOS (12.2±6.8 vs. 9.0±2.1 days, p=0.03).

    Conclusions:

    • Targeted auditing of patients not meeting ERP expectations is an effective strategy for identifying implementation defects.
    • System-level interventions driven by audit findings can improve specific process measures.
    • Focusing audits on outliers can significantly reduce prolonged length of stay, enhancing ERP effectiveness.