Haemodynamic Monitoring in Enhanced Recovery Program: Improved Colorectal Surgery Patient Outcomes

We’ve heard and written a lot about so-called Enhanced Recovery Programs (ERP). Adoption of an ERP takes the form of a set of predefined practices designed to standardize some aspects of surgical care. The aim is to help patients recover more quickly and heal faster after surgery.

Here’s a worked example from Bon Secours St. Mary’s Hospital, Richmond, Virginia. The program has already enrolled more than 100 elective open and laparoscopic colorectal surgery cases since its inception in August 2016.

The program

Candidates for elective colorectal surgery receive preoperative education including the plan for managing postoperative pain and diet.

Patients receive dietary supplements to boost protein and aid healing. And instead of traditional fasting prior to surgery, the program allows ERP patients to drink clear liquids up to two hours prior to surgery and drink a carbohydrate drink as well. Other main tenets of the ERP program include a standardized pain management plan and standardized discharge instructions post-surgery.

Another stipulation is that all surgical patients undergo perioperative haemodynamic monitoring using the ODM+ platform. This measure was introduced based on evidence that fluid management yielded fewer complications and contributed to earlier patient discharge.

Improved outcomes

Clinical staff have documented dramatic improvements in colorectal surgery quality outcomes. These include a two-day reduction in length of stay, down from approximately six days pre-ERP to four days with ERP. Other patient benefits include reduced incidence of surgical site infections, and lower readmission rates. The program aims to reduce opioid intake through the use of other non-opioid pain management strategies. Indeed since August of 2016, the team at St. Mary’s has seen an 80% reduction of postoperative opioid use.

What the healthcare professionals say

General Surgeon, Dennis Cohen, M.D. stated: “Before the Enhanced Recovery Program launched, each colorectal surgeon would have their own methodologies such as when patients would stop liquids or when they could be discharged. Now, care is standardized so that every elective colorectal surgery patient experiences the same before and after protocols, which leads to better outcomes.”

Another guiding principle, as outlined by Dr Cohen, is that “by making patients active participants in their own care, they tend to do better.

“The patient goes into surgery with a clear idea of what they can expect, such as how their pain will be controlled and when they can eat or drink.”

Rebecca Eades, advanced practice nurse and ERP coordinator said: “We are very proud of the team-centered, evidence-based practice approach that has been applied to this program. All components are based on the most recent research.”

Deltex comments

Deltex CEO Ewan Phillips concludes; “It’s gratifying to see a hospital following the evidence and reaping the rewards. Since adopting ERP including the ODM+ system this hospital has achieved improved patient outcomes and that all-important efficiency that results from earlier patient discharge. Add the fact that haemodynamic monitoring with ODM+ pays for itself in avoidance of costly complications and it becomes a great example of how investing in and deploying state-of-the-art technology can deliver value for healthcare providers.”