INTRODUCTION Commonly cited studies have reported substantial improvements (defined as >20%) in process measure compliance after implementation of colorectal enhanced recovery programs (ERP). However, hospitals have anecdotally reported difficulties in… Click to show full abstract
INTRODUCTION Commonly cited studies have reported substantial improvements (defined as >20%) in process measure compliance after implementation of colorectal enhanced recovery programs (ERP). However, hospitals have anecdotally reported difficulties in achieving similar improvement gains. This study evaluates improvement uniformity among 151 hospitals exposed to an 18-month implementation protocol for 6 colorectal ERP process measures (oral antibiotics, mechanical bowel preparation, multimodal pain control, early mobilization, early liquid intake, early solid intake). METHODS 151 hospitals implemented a colorectal ERP with pathway, educational and supporting materials, and data capture protocols. 906 opportunities existed for process compliance improvement across the cohort (151 hospitals x 6 process measures). However, 240 opportunities were excluded due to high starting compliance rates (i.e., compliance >80%) and 3 opportunities were excluded as compliance rates were recorded for <2 cases. Thus, 663 opportunities for improvement across 151 hospitals were studied. RESULTS Of 663 opportunities, minimal improvement (0 - 20% increase in compliance) occurred in 52% of opportunities, substantial improvement (>20% increase in compliance) in 20%, while worsening compliance occurred in 28%. Of the 6 processes, multimodal pain control and use of oral antibiotics improved the most. CONCLUSIONS Contrary to published ERP literature, the majority of study hospitals had difficulty improving process compliance with 80% of the opportunities not achieving substantial improvement. This discordance between ERP implementation success rates reported in the literature and what is observed in a large sample could reflect differences in hospitals' culture or characteristics, or a publication bias. Attention needs to be directed towards improving ERP adoption across the spectrum of hospital types.
               
Click one of the above tabs to view related content.