Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery

Michael C. Grant, Andrew Hanna, Andrew Benson, Deborah Hobson, Christopher L. Wu, Christina Yuan, Michael Rosen, Elizabeth C. Wick

Research output: Contribution to journalArticle

Abstract

Background: Our aim was to determine whether the establishment of a dedicated operating room team leads to improved process measure compliance and clinical outcomes in an Enhanced Recovery after Surgery (ERAS) program. Enhanced Recovery after Surgery programs involve the application of bundled best practices to improve the value of perioperative care. Successful implementation and sustainment of ERAS programs has been linked to compliance with protocol elements. Study Design: Development of dedicated teams of anesthesia providers was a component of ERAS implementation. Intraoperative provider team networks (surgeons, anesthesiologists, and certified registered nurse anesthetists) were developed for all cases before and after implementation of colorectal ERAS. Four measures of centrality were analyzed in each network based on case assignments, and these measures were correlated with both rates of process measure compliance and clinical outcomes. Results: Enhanced Recovery after Surgery provider teams led to a decrease in the closeness of anesthesiologists (p = 0.04) and significant increase in the clustering coefficient of certified registered nurse anesthetists (p = 0.005) compared with the pre-ERAS network. There was no significant change in centrality among surgeons (p = NS for all measures). Enhanced Recovery after Surgery designation among anesthesiologists and nurse anesthetists-whereby individual providers received an in-service on protocol elements and received compliance data was strongly associated with high compliance (>0.6 of measures; p < 0.001 for each group). In addition, high compliance was associated with a significant reduction in length of stay (p < 0.01), surgical site infection (p < 0.002), and morbidity (p < 0.009). Conclusions: Dedicated operating room teams led to increased centrality among anesthesia providers, which in turn not only increased compliance, but also improved several clinical outcomes.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
DOIs
StateAccepted/In press - Jan 1 2018

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Colorectal Surgery
Operating Rooms
Compliance
Nurse Anesthetists
Process Assessment (Health Care)
Anesthesia
Nurses
Perioperative Care
Guideline Adherence
Surgical Wound Infection
Practice Guidelines
Cluster Analysis
Length of Stay
Morbidity

ASJC Scopus subject areas

  • Surgery

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Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery. / Grant, Michael C.; Hanna, Andrew; Benson, Andrew; Hobson, Deborah; Wu, Christopher L.; Yuan, Christina; Rosen, Michael; Wick, Elizabeth C.

In: Journal of the American College of Surgeons, 01.01.2018.

Research output: Contribution to journalArticle

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