Journal
WORLD JOURNAL OF SURGERY
Volume 45, Issue 2, Pages 347-355Publisher
SPRINGER
DOI: 10.1007/s00268-020-05810-w
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Funding
- National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre
- St Mark's Association
- Health Foundation
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The study found that standardized, ERP-based care was almost universal in hospitals, but clinician adherence varied significantly. Analysis showed that units with higher clinician adherence achieved shorter length of stay, which was correlated with higher ratings of teamwork and support for complication management.
Background Randomised trials have shown an Enhanced Recovery Program (ERP) can shorten stay after colorectal surgery. Previous research has focused on patient compliance neglecting the role of care providers. National data on implementation and adherence to standardised care are lacking. We examined care organisation and delivery including the ERP, and correlated this with clinical outcomes. Methods A cross-sectional questionnaire was administered to surgeons and nurses in August-October 2015. All English National Health Service Trusts providing elective colorectal surgery were invited. Responses frequencies and variation were examined. Exploratory factor analysis was performed to identify underlying features of care. Standardised factor scores were correlated with elective clinical outcomes of length of stay, mortality and readmission rates from 2013-15. Results 218/600 (36.3%) postal responses were received from 84/90 (93.3%) Trusts that agreed to participate. Combined with email responses, 301 surveys were analysed. 281/301 (93.4%) agreed or strongly agreed that they had a standardised, ERP-based care protocol. However, 182/301 (60.5%) indicated all consultants managed post-operative oral intake similarly. After factor analysis, higher hospital average ERP-based care standardisation and clinician adherence score were significantly correlated with reduced length of stay, as well as higher ratings of teamwork and support for complication management. Conclusions Standardised, ERP-based care was near universal, but clinician adherence varied markedly. Units reporting higher levels of clinician adherence achieved the lowest length of stay. Having a protocol is not enough. Careful implementation and adherence by all of the team is vital to achieve the best results.
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