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