Toolkit: Enhanced Recovery Protocols for Colorectal Surgery

Performance Reports

  • Hospitals that have signed participation agreements will be eligible to receive benchmarked performance reports that include risk-adjusted metrics for length of stay and readmission after colorectal surgery.
  • These reports are created using existing data from the Wisconsin Hospital Association (WHA), and thus do not require any data collection or data submission by hospitals.
  • Please click here to see a generic template for the SCW colorectal surgery hospital-level performance report.

Action Plan

  • Action plan worksheets created specifically for the Enhanced Recovery Protocols for Colorectal Surgery initiative can be used to prioritize QI efforts and sent project goals.

Selected Articles

 

Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Feldman LS, Steele SR. Dis Colon Rectum.2017 Aug;60(8):761-784.

 Guidelines developed as a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

  • Created to define current best-quality care for enhanced recovery after colon and rectal surgery.
  • Summarizes evidence supporting recommendations for specific components of protocol.

Surgical Technical Evidence Review for Colorectal Surgery Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery Ban KA, Gibbons MM, Ko CY, Wick EC. J Am Coll Surg. 2017. Oct;225(4):548-557.

 The Agency for Healthcare Research and Quality (AHRQ) in partnership with the American College of Surgeons and Johns Hopkins University developed a program to help hospitals across the country implement enhanced recovery protocols.

  • The specific program they developed is based on this review paper, which is a comprehensive summary of the rationale and evidence supporting the individual surgical components of enhanced recovery protocols (anesthesia components are reported separately).

 Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Colorectal Surgery. Ban KA, Gibbons MM, Ko CY, Wick EC, Cannesson M, Scott MJ, Grant MC, Wu CL. Anesth Analg. 2018 Apr 11

 The Agency for Healthcare Research and Quality (AHRQ) in partnership with the American College of Surgeons and Johns Hopkins University developed a program to help hospitals across the country implement enhanced recovery protocols.

  • The specific program they developed is based on this review paper, which is a comprehensive summary of the rationale and evidence supporting the individual Anesthesia components of enhanced recovery protocols (surgical components are reported separately)

 Improving Surgical Value and Culture Through Enhanced Recovery Programs. Lee L, Feldman LS. JAMA Surg. 2017 Mar 1;152(3):299-300.

Implementation of an Enhanced Recovery After Surgery Program for Colorectal Surgery at a Community Teaching Hospital. Bray MS, Appel AL, Kallies KJ, Borgert AJ, Zinnel BA, Shapiro SB. WMJ. 2017 Feb;116(1):22-6.

  • In 2014, Gunderson Health System implemented an enhanced recovery after surgery protocol.  This article summarized the details of their protocol as well as the approach they used for development and implementation, highlighting the importance of multidisciplinary collaborative approach.
  • In the first year of the program, length of stay was successfully reduced without a significant difference in morbidity or mortality.

 “Practice Guideline for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures” .

 Includes specific recommendation from American Society of Anesthesiologists (ASA) to allow patients to drink clear liquids until up to 2 hours before receiving general anesthesia.

Strong for Surgery

 “American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery”

  • Includes specific recommendations regarding diet management and prevention of nausea and ileus.
  • Click here for graphic of I-FEED scoring system guiding advancement of diet postoperatively.

“American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part1-From the Preoperative Period to PACU”

  • Comprehensive approach to “optimal analgesia” covering prop through PACU.

“American Society for Enhanced Recovery (ADER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home”

  • Comprehensive approach to “optimal analgesia” covering PACU to discharge.

“Postoperative Multimodal Analgesia Pain Management with Non-opioid Analgesics and Techniques: A Review”

  • Includes summaries of multiple options for non-opioid pain management.