ABSTRACT
Enhanced recovery programs (ERPs) can improve outcomes following bowel surgery, but implementing an ERP across a large healthcare system remains challenging. In this study, a simplified ERP that focused on two process steps, early and frequent ambulation and early alimentation, was evaluated to determine its impact on outcomes. Data were collected on 5,000 adult patients undergoing elective small and large bowel operations over a 3-year period. Complication, readmission, and mortality rates were evaluated before and after ERP implementation. A composite score was calculated based on the successful completion of the two process steps. Following implementation, there was a 35.1% increase in the composite score, which was associated with significant (p < .05) reductions in overall complications, gastrointestinal complications, pulmonary complications, and readmissions. A system-wide ERP focusing on early and frequent ambulation and early alimentation is associated with decreased complications and readmissions in adult patients admitted for elective small or large bowel operations.
Subject(s)
Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/surgery , Length of Stay/statistics & numerical data , Patient Readmission/statistics & numerical data , Postanesthesia Nursing/standards , Postoperative Complications/prevention & control , Practice Guidelines as Topic , Adult , Digestive System Physiological Phenomena , Early Ambulation/standards , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Urinary Tract Physiological PhenomenaABSTRACT
The objective of this study was to determine if a Patient Blood Management (PBM) program implemented for patients undergoing THA or TKA would result in a decrease in the percentage of patients transfused PRBCs and improve outcomes. Decision support, a key driver for this program, was built into the electronic medical record. This retrospective cohort study included 12,590 patients and demonstrated a 44% decrease in the percentage of patients transfused. This was associated with a significant reduction in complications, 30 day readmissions and HLOS. A PBM program for patients undergoing prosthetic joint arthroplasty for primary and revision total hip and knee arthroplasty results in fewer transfusions and is associated with improved outcomes.
