Ruben van Zelm1,2,3, Ellen Coeckelberghs4,5, Walter Sermeus4,5, Anthony De Buck van Overstraeten6, Arved Weimann7, Deborah Seys4, Massimiliano Panella4,5,8, Kris Vanhaecht4,5,9. 1. Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium. Ruben.vanzelm@kuleuven.be. 2. European Pathway Association, Leuven, Belgium. Ruben.vanzelm@kuleuven.be. 3. Q-Consult zorg, Utrecht, The Netherlands. Ruben.vanzelm@kuleuven.be. 4. Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium. 5. European Pathway Association, Leuven, Belgium. 6. Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium. 7. Department of General, Abdominal, and Oncological Surgery, Klinikum Skt George, Leipzig, Germany. 8. Department of Translational Medicine, University of Eastern Piemonte (UPO), Novara, Italy. 9. Department of Quality Management, University Hospitals Leuven, Leuven, Belgium.
Abstract
PURPOSE: Surgical care for patients with colorectal cancer has become increasingly standardized. The Enhanced Recovery After Surgery (ERAS) protocol is a widely accepted structured care method to improve postoperative outcomes of patients after surgery. Despite growing evidence of effectiveness, adherence to the protocol remains challenging in practice. This study was designed to assess the adherence rate in daily practice and examine the relationship between the importance of interventions and adherence rate. METHODS: This international observational, cross-sectional multicenter study was performed in 12 hospitals in four European countries. Patients were included from January 1, 2014. Data was retrospectively collected from the patient record by the local study coordinator. RESULTS: A total of 230 patients were included in the study. Protocol adherence was analyzed for both the individual interventions and on patient level. The interventions with the highest adherence were antibiotic prophylaxis (95%), thromboprophylaxis (87%), and measuring body weight at admission (87%). Interventions with the lowest adherence were early mobilization-walking and sitting (9 and 6%, respectively). The adherence ranged between 16 and 75%, with an average of 44%. CONCLUSION: Our results show that the average protocol adherence in clinical practice is 44%. The variation on patient and hospital level is considerable. Only in one patient the adherence rate was >70%. In total, 30% of patients received 50% or more of the key interventions. A solid implementation strategy seems to be needed to improve the uptake of the ERAS pathway. The importance-performance matrix can help in prioritizing the areas for improvement.
PURPOSE: Surgical care for patients with colorectal cancer has become increasingly standardized. The Enhanced Recovery After Surgery (ERAS) protocol is a widely accepted structured care method to improve postoperative outcomes of patients after surgery. Despite growing evidence of effectiveness, adherence to the protocol remains challenging in practice. This study was designed to assess the adherence rate in daily practice and examine the relationship between the importance of interventions and adherence rate. METHODS: This international observational, cross-sectional multicenter study was performed in 12 hospitals in four European countries. Patients were included from January 1, 2014. Data was retrospectively collected from the patient record by the local study coordinator. RESULTS: A total of 230 patients were included in the study. Protocol adherence was analyzed for both the individual interventions and on patient level. The interventions with the highest adherence were antibiotic prophylaxis (95%), thromboprophylaxis (87%), and measuring body weight at admission (87%). Interventions with the lowest adherence were early mobilization-walking and sitting (9 and 6%, respectively). The adherence ranged between 16 and 75%, with an average of 44%. CONCLUSION: Our results show that the average protocol adherence in clinical practice is 44%. The variation on patient and hospital level is considerable. Only in one patient the adherence rate was >70%. In total, 30% of patients received 50% or more of the key interventions. A solid implementation strategy seems to be needed to improve the uptake of the ERAS pathway. The importance-performance matrix can help in prioritizing the areas for improvement.
Entities:
Keywords:
Care pathways; Colorectal surgery; ERAS; Importance-performance analysis; Protocol adherence
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