Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience

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1 Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC Our Data Experience

2 No Disclosures 1/26/2015 2

3 Purpose To tell our story of how we collect and share our ERACS data 1/26/2015 3

4 Our Team Team Members Dr. Tom Wallace Surgeon Lead Dr. Bruce Kilpatrick Anesthesia Lead Denise Chartrand Administration Sponsor Donna Martin Mgr. PSS/DCS/PAR Nancy Garrett-Petts Educator DCS/PAR Anja Case PCC DCS/PSS Jayme Scott (Tami Leggatt) PCC 6 South Michelle Watson Educator 6 South Cindy O Brien Data Collection Julie Wootton QI Support Monica Stegar/Karen King ET Nurses Kim Winters Pharmacy (Ad Hoc) Jeff Frisen Physio (Ad Hoc) Jodi Richardson/Dawn Benwell Dietician (Ad Hoc) Cheryl Sibbelee / Kerry Cardwell NSQIP SCR auditors 26/01/2015 4

5 Overview of ERACS at RIH RIH is a 239 bed hospital Approx. 140 Colorectal Cases / Year January st Interdisciplinary team meeting July 2014 ERIN Module available in NSQIP November patients audited 27 with 30 day follow up September 2013 First IH ERACS Meeting March / April 2014 Staff Education December 2013 Pre ERACS Audits January March 2014 Documentation reviewed and revised May 21, 2014 First ERACS patient September 2014 First audits 10 patients 26/01/2015 5

6 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 1/26/2015 6

7 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 1/26/2015 7

8 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 1/26/2015 8

9 Process data 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 1/26/2015 9

10 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 1/26/

11 Our results to date (36 patients audited 27 patients with 30 day follow up) 1/26/

12 ERACS Pre Op Element Compliance 36 Patients 100% 90% 80% 100% 81% 92% 75% 100% 100% 83% 70% 60% 50% 50% 40% 30% 20% 10% 0% Preadmission Oral Bowel Prep Patient Education (YES) IMPACT AR Taken Carbohydrade Drink (Vitajoule) Long acting sedative medication NOT given Thrombosis Prophylaxis (IH Guidelines) SCDs Used Antiobiotic Prophylaxis 0-60 min prior to incision (Yes)

13 100% ERACS Intra-Op Element Compliance 36 patients 97% 90% 83% 86% 89% 80% 75% 70% 60% 50% 40% 30% 20% 10% 0% PONV prophylaxis administered Upper body forced air heating covered (YES) Post op Nasogastric tub NOT used in OR Abdominal drains NOT used Fluid Administration Guidance (YES)

14 Stimulation of gut motility w chewing Gum Mobilization POD 0 Mobilization POD 1 Mobilization POD 2 Termination of Urinary Catheter POD 1-2 No Nausea POD 0 No Nausea POD 1 No Naseaa POD 2 Ensure/Boost x 2/day POD 1 Ensure/Boost x 2/day POD 2 ERACS Post Op Element Compliance 36 patients 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 86% 42% 67% 53% 86% 19% Patient log book information not always available 25% 31% 36% 31%

15 Lenght of Stay pts. Jan 1, 2013 April 30, 2014 (NSQIP) Pre ERACS Implementation average LOS Pre & Post ERACS LOS 5 36 pts May 21, 2014 October 28, 2014 Post ERACS Implementation average LOS Length of Stay Patient

16 Post Op Outcomes 27 patients with 30 day follow up 1/26/

17 Pre ERACS Post Op Outcomes January 1, April 30, 2014 (NSQIP Non risk adjusted data) 137 Elective patients Unplanned reoperation Postoperative Death > 30 Days of Procedure if in Acute Care Still in Hospital > 30 Days Septic Shock Sepsis Vein Thrombosis Requiring Therapy Transfusion Intra/Postop (RBC within the First 72 Hrs of Intraoperative or Postoperative Myocardial Infarction Intraoperative or Postoperative Cardiac Arrest Requiring CPR Stroke/Cerebral Vascular Accident (CVA) Urinary Tract Infection Progressive Renal Insufficiency/Acute Renal Failure Requiring Pulmonary Embolism On Ventilator > 48 Hours Intraoperative OR Postoperative Unplanned Intubation Pneumonia Wound disruption Organ/Space SSI Deep Incisional SSI Superficial Incisional SSI 1.5% 2.1% 3.0% 1.5% 1.5% 0.7% 1.5% 1.5% 1.5% 1.5% 5.0% 7.2% 8.7% 12.4% 2.0% 4.0% 6.0% 8.0% % 14.0%

18 Post ERACS Post Op Occurrences May 21, August 20, 2014 (NSQIP Non risk adjusted data) 27 Elective patients Unplanned reoperation Postoperative Death > 30 Days of Procedure if in Acute Care Still in Hospital > 30 Days Septic Shock Sepsis Vein Thrombosis Requiring Therapy Transfusion Intra/Postop (RBC within the First 72 Hrs of Intraoperative or Postoperative Myocardial Infarction Intraoperative or Postoperative Cardiac Arrest Requiring CPR Stroke/Cerebral Vascular Accident (CVA) Urinary Tract Infection Progressive Renal Insufficiency/Acute Renal Failure Pulmonary Embolism On Ventilator > 48 Hours Intraoperative OR Postoperative Unplanned Intubation Pneumonia Wound disruption Organ/Space SSI Deep Incisional SSI Superficial Incisional SSI 4.0% 4.0% 4.0% 18.5% 2.0% 4.0% 6.0% 8.0% % 14.0% 16.0% 18.0% 2

19 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 1/26/

20 Sharing Data 1/26/

21 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 1/26/

22 Thank you Excellent personalized care. Had great follow up by surgeon, surgical resident, anesthetist, recovery room nurse and nurse in charge of ERACS Patient feedback collected through the NSQIP 30 Day follow up 1/26/