ERAS GYN-ONC
CLINICAL EFFECTIVENESS
ERAS Improves Patient Care and Outcomes in Gynecologic Oncology In July 2016, the UAB Care clinical effectiveness team partnered with the Division of Gynecologic Oncology( Gyn / Onc) to implement the Enhanced Recovery after Surgery( ERAS) pathway for patients undergoing elective total abdominal hysterectomy( TAH) and bilateral salpingo-oophorectomy( BSO) procedures. Preliminary work on the ERAS gyn / onc project began in late summer 2016, with the UAB Care team facilitating a rapid redesign session in September 2016 in collaboration with Michael Straughn, MD, Charles Leath, MD, Prentiss Lawson, MD, and nursing leads Erica Lumpkin, Terrell Halcomb, and Carissa Purvis.
“ Bringing together members of our care team for a focused discussion on how to implement ERAS for our total abdominal hysterectomy and bilateral salpingo-oophorectomy procedures allowed us to collaboratively define a pathway of treatment, identify barriers, and define the‘ UAB Way’ for treating these patients,” says Michael Straughn, MD, Gynecologic Oncology fellowship director for UAB.“ Working with the UAB Care team, which helped focus our discussions, allowed us to quickly identify areas of opportunity and provided clear objectives and consensus among team members.”
The team developed leading practice guidelines( LPGs) for the ERAS gyn / onc pathway, incorporating evidence-based and operational best practices for effectively treating these patients before, during, and after surgery. Five key initiatives were identified:
• ERAS patient education
• Development of pre-op and post-op ERAS order sets
• ERAS staff education
• Optimization of clinic processes for scheduling ERAS patients
• Standardization of Inpatient Pain Service( IPS) processes for ERAS TAH and BSO patients. The key initiatives were implemented in November 2016.
TABLE 1. ERAS PERFORMANCE RESULTS COMPARED AGAINST GOALS AND BENEFITS
BASELINE PERFORMANCE( FY15)
GOAL( FY17)
PERFORMANCE PERIOD( FY17 JUNE)
Length of stay index 1.10 0.95 0.74
Average length of stay 4.2 days 2.8 days
% 30 day readmissions 6.7 % 6.0 % 5.9 %
% surgical site infections 2.2 % 1.0 % 0.5 %
Average variable costs per case $ 4,493 $ 4,200 $ 4,377
Through June 2017, 249 patients have gone through the TAH / BSO ERAS pathway. To date, improved outcomes have been demonstrated in a reduction in length of stay and surgical site infections among patients eligible for the ERAS pathway. To help ensure that positive outcomes are sustained, 15 ERAS-specific process metrics and patient outcomes are being monitored and routinely reported among project and organization leaders.
22 UAB Quality and Safety Annual Report