Within the first year of implementation, the UAB Division of Gynecologic Oncology (Gyn/Onc) is experiencing success with the enhanced recovery after surgery (ERAS) pathway for its elective total abdominal hysterectomy and bilateral salpingo-oophorectomy patient populations.
In November 2016, the UAB Care team partnered with a physician leadership team of Michael Straughn, MD, Charles Leath, MD, and Prentiss Lawson, MD, to develop Leading Practice Guidelines (LPGs) for ERAS Gyn/Onc that reflect best practices in the field and within UAB Medicine.
The goals of the ERAS protocol include improving patient outcomes, decreasing costs, and reducing length of stay (LOS).
Dr. Straughn says implementing the ERAS protocol has positively impacted outcomes.
“The biggest thing we were worried about was increasing the 30-day readmission rate, which had been pretty stable,” he says. “We’ve been impressed with the data.”
Compared with the baseline results recorded before ERAS implementation, Gyn/Onc has seen reductions in the 30-day readmission rate, length of stay, and costs per case.
Much of the credit for the success goes to the UAB Care team, according to Dr. Straughn.
“UAB Care provided us with all the resources to make it happen,” he says. “They set out timelines, goals, and data. UAB Care provided lots of support and the training we needed to get everyone up to speed. It was the most well-run initiation of a clinical protocol that I have ever been a part of.”
The LPGs for the Gyn/Onc ERAS prescribe a standardized method of treatment designed to eliminate variation in care practices, helping generate the positive results.
“The variation in how patients were cared for over the last 20 years was significant,” Dr. Straughn says. “Some faculty fed patients early; some held their food for a few days. Ambulation requirements varied depending on the nurses. The amount of narcotics we gave them perioperatively and once we sent them home was not well-regulated.”
This standardization of care has benefited patients.
“ERAS allows for shared decision-making. Patients understand and are a part of their care,” Dr. Straughn says. “They have less pain and appear to have fewer perioperative complications because they get home sooner. The amount of narcotics they take in the hospital and at home is much less than in the past, which is a good thing considering the opioid crisis in our country and Alabama.”
Manager of Quality Improvement Anisa Xhaja, MHA, MSHQS, says involving patients in their own care is a central theme in all ERAS protocols.
“ERAS creates an interdisciplinary team effort for patient care that is well-organized, coordinated, and consistent throughout the system,” she says. “What is even more special about ERAS is that it places patients at the center of their own care and engages them, from the decision to have surgery to when they go home.”
Dr. Straughn says the ERAS protocol is being expanded, where appropriate, to other gynecologic patient populations.