QAPI 129 - How an Enhanced Recovery After Surgery Pathway for Colorectal Patients Improved Patient Outcomes

Background: Surgical site infections following colorectal surgery are associated with worse postoperative outcomes and longer lengths of stay. Better patient outcomes are correlated with the implementation of enhanced recovery pathways, centered on perioperative care best practices. This quality improvement project focused on one Midwest regional health system’s involvement in creation and implementation of an evidence-based clinical pathway for colorectal patients.

Methods: A multi-disciplinary team was created to develop and implement an Enhanced Recovery After Surgery surgical pathway for all scheduled colorectal patients. This included all perioperative areas. Preoperative and intraoperative checklists to help the nurses remember all components was created. Physician order sets were created to standardize interventions, patient education through the clinic was created and staff training was completed. Comparison of pre- and post-pathway surgical site infections, length of stay, use of multi-modal pain management, use of regional anesthesia and mean days of return of bowel function were performed.

Results: Baseline data from 29 colorectal surgery patients was collected pre-pathway in 2021 and was compared to 132 collected post-pathway from 2022-2023. Colorectal standardized infection ratios (SIRs) decreased from 0.167 pre-pathway to zero post-pathway. The median length of stay for a colorectal patient decreased by 1.8 days. Use of multi-modal pain management increased by 46.6% and use of regional anesthesia increased by 59.3%. The mean number of days until return of bowel function for a colorectal patient post pathway decreased by 1.1 days compared to pre-pathway.

Conclusions: Implementation of an Enhanced Recovery After Surgery colorectal pathway resulted in improvements in patient management and outcomes. The keys to success were the continued involvement of a multi-disciplinary team and strong relationships between the clinic and hospital. Hospitals struggling with higher colorectal surgical site infections can use the framework developed in this quality improvement project to improve patient care and safety.