Enhanced Recovery Programme Elective Colorectal Surgery Hywel Dda Health Board Glangwili Hospital
19
Enhanced Recovery Programme Elective Colorectal Surgery Hywel Dda Health Board Glangwili Hospital
description
Enhanced Recovery Programme Elective Colorectal Surgery Hywel Dda Health Board Glangwili Hospital. ERAS at Glangwili:. Implemented 13th September 2010 All elective colorectal surgical procedures All 4 Consultant surgeons signed up - PowerPoint PPT Presentation
Transcript of Enhanced Recovery Programme Elective Colorectal Surgery Hywel Dda Health Board Glangwili Hospital
Enhanced Recovery ProgrammeElective Colorectal Surgery
Hywel Dda Health BoardGlangwili Hospital
ERAS at Glangwili:
Implemented 13th September 2010
All elective colorectal surgical procedures
All 4 Consultant surgeons signed up
Full MDT involvement (physio, dietitian, colorectal CNS, anaesthetists, surgeons, pre-assessment, ward staff)
Data from initial 79 patients: Mortality n=3 (<4%) Data of remaining 76 patients Average age 69.1 years Re-admission rate n=3 (<4%) Open procedures n= 74 (97%) Laparoscopic n=2 (3%)
Total length of stay: 3 day reduction in LOS through implementation of
ERAS
10.6
7.6
0
2
4
6
8
10
12
Pre-ERAS
ERAS
Post-op length of stay: 9.6
6.7
0
1
2
3
4
5
6
7
8
9
10
Pre-ERAS
ERAS
Total LOS run chart: Length of stay - In Hospital
Hywel Dda Health Board, Glangwili Hospital Colorectalfrom Sep 2010 to Aug 2011
0
2
4
68
10
12
14
16
2 1 46 25 17 27 21 34 36 32 57 65 60 54 70 73
Patient ID
Day
s
No target
Reduction in LOS not achieved through change to DOSA as only 9% of patients admitted the day of surgery
If DOSA admission was implemented total LOS would be reduced to 6.7 days
Type of surgery:
Sigmoid colectomy
23%
AP-resection5%
Other7%
Ant resection31%
R-hemicolectomy
34%R-hemicolectomy
Ant resection
Sigmoid colectomy
AP-resection
Other
Bundle compliance: Immediate Care B2% pts complying with Immediate Care Bundle B2
Hywel Dda Health Board, Glangwili Hospital Colorectalfrom Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Individual elements affecting B2 bundle compliance:
% pts weighed Hywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Median 100.0
% pts with nutritional tool completed Hywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Median 100.0
Bundle compliance: Intra-operative care B3
% pts complying with Intra-operative care bundle B3Hywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Individual elements affecting B3 bundle compliance:
% pts weighed dailyHywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Median 0.0
% pts where Bowel Preparation avoidedHywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Median 36.7
DOSA: Identified as area for improvement at LS4
% pts admitted on day of surgeryHywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Median 0.0
Bundle compliance: Post-operative Care B4
% pts completing Post Operative Care Bundle B4Hywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Individual elements affecting B4 bundle compliance
% of patients (median):
- Timely IV fluid removal 66.7%
- Timely catheter removal 63.3%
- Sat out in chair 6-8 hours daily 86.1%
- Achieved x4 walks daily 63.3%
- Sat out in chair day of surgery 27.8%
Bundle compliance: Discharge/Follow-up B5
% of pts completing the Discharge/follow up bundle B5Hywel Dda Health Board, Glangwili Hospital Colorectal
from Sep 2010 to Aug 2011
0
20
40
60
80
100
Sep2010
Oct2010
Nov2010
Dec2010
Jan2011
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug2011
Months
% p
atie
nts
Areas identified for improvement: Post-operative fluid management
Daily weighing of patients
Staff education due to recent ward changes
Increase bundle compliance
Positives: Improved team work Continued enthusiasm Sustained reduction in LOS Agreement with surgeons re: bowel prep Move towards DOSA Adapted ERAS documentation to include
POMS, daily weight and fluid management plan
Thank you
