Does better documentation compliance with ERAS protocol translate to improved clinical outcome?

Abstract

Aim:

Enhanced Recovery After Surgery (ERAS) programmes involve multimodal optimisation of patient care throughout their surgical stay. The aim of this study was to determine if better ERAS protocol documentation compliance was associated with improved clinical compliance and better clinical outcomes.

Method:

A retrospective cohort study was conducted of 97 (F=50) patients enrolled in the hospital’s ERAS programme over two 4-month time periods in consecutive years, 2019 and 2020. Three ERAS pathways were used, 1) bowel resection with stoma, 2) bowel resection without stoma, and 3) closure of stoma. Outcome measures were benchmarked against key ERAS aspects.

Results:

Approximately 45% of patients on the bowel resection with stoma and closure of stoma pathway met the ERAS benchmark. Patients on the bowel resection without stoma pathway had the poorest compliance at only 26%. Many instances of incorrect pathway allocation and poor documentation occurred, while only 62% of patients did not complete the pathway form.

Conclusion:

This study has shown that there is no correlation with better documentation to improve clinical outcomes on the ERAS pathway. It has also provided an insight of the ERAS culture in our organisation. Our findings suggest that pre-admission counselling is a significant part of ERAS as this sets the expectations for patients and the need for a dedicated person to provide this counselling, as well as continuous collaboration and education to staff so they could provide the right advice for patients..In terms of the documentation on the ERAS pathway, the responsibility should be shared across the multidisciplinary team.