Enhanced Recovery After

Colorectal Surgery at Royal Inland Hospital

Kamloops, BC

Our Data Experience

No Disclosures

2/16/2015 2

Purpose • To tell our story of how we collect and share

our ERACS data

2/16/2015 3

Overview of ERACS at RIH RIH is a 239 bed hospital

Approx. 140 Colorectal Cases / Year

16/02/2015 4

January 2014 1st Interdisciplinary

team meeting

December 2013 Pre ERACS Audits

January – March 2014 Documentation

reviewed and revised

March / April 2014 Staff Education

May 21, 2014 First ERACS patient September 2014

First audits 10 patients

September 2013 First IH ERACS Meeting

November 2014 36 patients audited

27 with 30 day follow up

July 2014 ERIN Module

available in NSQIP

How we collect data

• Started with auditing our ERACS patients

using the EIAS data tool

• July 2014 – NSQIP SCRs collected all

Colorectal cases in the ERIN module

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Data Collection Challenges • EIAS audit tool time consuming

• Reports in EIAS data base did not show all information we wanted

• Patient log books not always completed

• Both ERACS and NSQIP auditing the same charts

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What we did • Created own spreadsheet with pathway elements staff/physicians

and team wanted to see (Based on feedback)

• Created graphs from custom spreadsheet

• Used NSQIP process for 30 day follow up

• Communication to surgical units regarding patient log books

• Communication to Health Information regarding patient log books

2/16/2015 7

Process data

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Pre Op Elements Intra Op Elements Post Op Elements

• ERACS Pre Admission Education

• Oral Bowel Prep Ordered/Taken

• IMPACT AR Ordered/Taken • Carbohydrate Drink

Ordered/Taken • Long acting sedative NOT

given • VTE Thrombosis Prophylaxis • SCDs Used • Antibiotic Prophylaxis 0-60

min of cut

• PONV prophylaxis • Upper body forced air • NG Tube NOT used in

OR • NO Abdominal drains • Fluid Administration

Guidance

• Chewing Gum • Mobilization POD 0 • Mobilization POD 1 • Mobilization POD 2 • Removal of urinary

catheter POD 1-2 • No Nausea POD 0 • No Nausea POD 1 • No Nausea POD 2 • Ensure/Boost x 2 POD 1 • Ensure/Boost x 2 POD 2

Outcome data • Length of Stay

• Post op complication (NSQIP) – Wound Occurrences

– Respiratory

– Urinary Tract

– CNS

– Cardiac

– Transfusion Intra/Post op (72 hrs of surgery)

– Vein Thrombosis Requiring Therapy

– Sepsis

– Septic Shock

2/16/2015 9

Our results to date

(36 patients audited – 27 patients with 30 day follow up)

2/16/2015 10

100%

81%

50%

92%

75%

100% 100%

83%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PreadmissionPatient

Education (YES)

Oral Bowel Prep IMPACT ARTaken

CarbohydradeDrink

(Vitajoule)

Long actingsedative

medication NOTgiven

ThrombosisProphylaxis (IH

Guidelines)

SCDs Used AntiobioticProphylaxis 0-60 min prior toincision (Yes)

ERACS Pre Op Element Compliance 36 Patients

83% 86%

97%

89%

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PONV prophylaxisadministered

Upper body forcedair heating covered

(YES)

Post op Nasogastrictub NOT used in OR

Abdominal drainsNOT used

Fluid AdministrationGuidance (YES)

ERACS Intra-Op Element Compliance 36 patients

86%

42%

67%

53%

86%

19% 25%

31% 36%

31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

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ERACS Post Op Element Compliance 36 patients

Patient log book information not always available

2 3 3 2 2 2 3 2 3

13

3

18

2 3 3 3

24

3

6

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5 4

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Len

ght

of

Stay

Patient

Length of Stay

7.6

5

00.5

11.5

22.5

33.5

44.5

55.5

66.5

77.5

88.5

99.510

Pre ERACS Implementation average LOS Post ERACS Implementation average LOS

Pre & Post ERACS LOS

137 pts. Jan 1, 2013 – April 30, 2014

(NSQIP)

36 pts May 21, 2014

October 28, 2014

Post Op Outcomes

27 patients with 30 day follow up

2/16/2015 15

137 Elective patients

5.0%

0.0%

7.2%

1.5%

1.5%

1.5%

1.5%

0.0%

0.0%

0.7%

0.0%

0.0%

1.5%

12.4%

0.0%

1.5%

3.0%

2.1%

1.5%

8.7%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%

Superficial Incisional SSI

Deep Incisional SSI

Organ/Space SSI

Wound disruption

Pneumonia

Intraoperative OR Postoperative Unplanned Intubation

On Ventilator > 48 Hours

Pulmonary Embolism

Progressive Renal Insufficiency/Acute Renal Failure Requiring…

Urinary Tract Infection

Stroke/Cerebral Vascular Accident (CVA)

Intraoperative or Postoperative Cardiac Arrest Requiring CPR

Intraoperative or Postoperative Myocardial Infarction

Transfusion Intra/Postop (RBC within the First 72 Hrs of…

Vein Thrombosis Requiring Therapy

Sepsis

Septic Shock

Still in Hospital > 30 Days

Postoperative Death > 30 Days of Procedure if in Acute Care

Unplanned reoperation

Pre ERACS Post Op Outcomes January 1, 2013 - April 30, 2014

(NSQIP Non risk adjusted data)

27 Elective patients

0.0%

0.0%

0.0%

4.0%

4.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

18.5%

0.0%

0.0%

0.0%

0.0%

0.0%

4.0%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0%

Superficial Incisional SSI

Deep Incisional SSI

Organ/Space SSI

Wound disruption

Pneumonia

Intraoperative OR Postoperative Unplanned Intubation

On Ventilator > 48 Hours

Pulmonary Embolism

Progressive Renal Insufficiency/Acute Renal Failure…

Urinary Tract Infection

Stroke/Cerebral Vascular Accident (CVA)

Intraoperative or Postoperative Cardiac Arrest Requiring CPR

Intraoperative or Postoperative Myocardial Infarction

Transfusion Intra/Postop (RBC within the First 72 Hrs of…

Vein Thrombosis Requiring Therapy

Sepsis

Septic Shock

Still in Hospital > 30 Days

Postoperative Death > 30 Days of Procedure if in Acute Care

Unplanned reoperation

Post ERACS Post Op Occurrences May 21, 2014 - August 20, 2014

(NSQIP Non risk adjusted data)

How we share our data

• Data posted in Nursing stations (DCS, PAR,

PSS, Surgical Unit).

• Data presented to physician groups

• Data presented to quality committee

• Shared with other IHA sites

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Sharing Data

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Next Steps • Review all documents

• Review process measures and post op outcomes

• Switch all data collection to ERIN module in NSQIP

• Add custom fields to NSQIP to obtain any information not collected

• Run reports through the NSQIP workstation

• Continue to share the data

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Thank you

“Excellent personalized care. Had great

follow up by surgeon, surgical resident,

anesthetist, recovery room nurse and

nurse in charge of ERACS”

2/16/2015 21

Patient feedback collected through the NSQIP 30 Day follow up