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Standardizing ERAS to Decrease Legnth of Stay
  • John Sudiacal, University of San Francisco
Background Information: ERAS protocols comprise a combination of various perioperative patient care methods using a multidisciplinary team approach that integrates evidence-based interventions that reduce surgical stress, maintain postoperative physiological function, and accelerate recovery in patients undergoing major surgery (Shida et. al., 2017). The objective of this performance improvement project is to ensure early ambulation and early nutrition are executed by nursing staff. The average early ambulation and early nutrition rates for ERAS patients during the period from February 1, 2016 to August 1, 2016 were (58%).

Global AIM: The post- surgical unit at Kaiser Permanente San Francisco (4C) will implement ERAS nursing care by either registered nurse (RN) or patient care technician (PCT) to reduce post-surgical complications and achieve a 20% reduction in LOS by December 2017.

Specific AIM: During the period of November 1, 2016 to August 1, 2017, KPSF will accomplish a > 80% rate for early ambulation and > 80% for early nutrition to shorten average length of stay from 6.6 days to < 5.3 days for post-operative colorectal patients.

Quality Gap: During a 9-month period, overall ERAS program compliance rate was 58%. Early nutrition rate was 52%, early ambulation rate was 64%, and sustained ambulation rate was 60%. Regional target sets a goal rate of 80% compliance.
Methods / Programs / Practices: The Clinical Nurse Leader (CNL) used the Institute of Improvement (IHI) model, Kotter’s 8 steps for successful change, and evidence based literature reviews to guide the implementation of nursing process change. The implementation lasted 9-months, included 2 PDSA cycles, and is currently in its sustainability PDSA cycle. Success of this project involved multidisciplinary and interdisciplinary teams; as well as support of unit-based councils, committees, and senior leadership.
Results: In a 9-month period, 234 (85%) ambulated within 12 hours post-op. 242 (88%) of ERAS patients on 4C sustained ambulation until day of discharge. 193 (70%) ERAS patients on 4C consumed nutrition within 12 hours post-op. The average length of stay for the 276 ERAS patient’s reduced by 1.9 days with an average LOS of 4.7 days. The goal of the project AIM (20% reduction in LOS), was exceeded due to successful implementation of ERAS protocol using CNL strategies, leadership guidance, and multidisciplinary cooperation.

Conclusion: The CNL functions as an advocate to both team member and patient. For the team, the CNL informs of ERAS benefits, adherence, and provides tools to assure regular practice among an interdisciplinary team. The CNL informs patients on the expectation of ERAS for the members of the team and assures their recovery as the highest priority. Additionally, the CNL acts as an outcomes manager by using ERAS data to change practice and improve outcomes. The CNL aims to achieve optimal patient outcomes through consistent practice of ERAS for colorectal post-operative patients.
  • ERAS,
  • Enhanced Recovery,
  • post-operative illeus,
  • Decrease Length of hospital Stay
Publication Date
Summer August 3, 2017
Field of study
Clinical Nurse Leadership
Dr. Nancy Taquino
Citation Information
John Sudiacal. "Standardizing ERAS to Decrease Legnth of Stay" (2017)
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