OR Manager - April 2020 - 22

Enhanced Recovery After Surgery
SPECIAL SERIES
Enhanced Recovery After Surgery is a set of evidencebased
clinical recommendations that, when combined,
improve surgical reliability and patient outcomes. At
Virginia Commonwealth University Health System in
Richmond, we leverage the power of data and analytics
to identify key performance indicators and opportunities,
and to monitor compliance to ensure patients receive
consistent optimal care.
In this article, we describe the tools and methodology we
use to gain insight into the determinants of patient care. This
article is the seventh in a series that began with the October
2019 issue of OR Manager.
Establishing and leveraging data analytics for ERAS
V
irginia Commonwealth University
Health System (VCU Health) in
Richmond is a Magnet facility,
and as such we continually examine
innovative ideas to improve the quality,
safety, and care of our patients.
Evidence has linked Enhanced Recovery
After Surgery (ERAS) with better outcomes,
and ERAS has become a focal
point at VCU Health.
Our data analysts compile and present
data to demonstrate the effectiveness
of ERAS protocols. OR leaders
use these data to gauge the level of
staff compliance, identify and correct
any gaps in the process, and determine
industry best practices.
Evolution of ERAS
Enhanced Recovery After Surgery was
developed as an evidence-based approach
in 1997 by a group of general
surgeons from Northern Europe led by
Henrik Kehlet, MD, PhD1. These founders
envisioned ERAS as a process that
would span the entire continuum of
care, from the clinic through the preoperative,
intraoperative, and postoperative
phases, with a multidisciplinary
team sharing information throughout
the patient's journey.
To meet the needs of individual patients
and monitor clinical outcomes,
the team was mindful of data integrity.
It was important to collect the right data,
share it, and analyze it to determine
whether the new protocols did indeed
improve outcomes. As an example, data
have supported the theory that reduced
use of opioids and increased mobility
22
OR Manager | April 2020
soon after surgery would shorten length
of stay and reduce costs.
As ERAS principles began to spread
from Sweden and throughout Europe to
Canada, the United States, and Latin
America, the team filed as a nonprofit
organization, called the ERAS Society.
The ERAS Society created an " ERAS
Interactive Audit System (EIAS), intended
for real-time quality control...
that became a powerful tool for clinical
research of the health care providers
involved with the ERAS Society network. " 2
Members
of the ERAS Society have
since leveraged the tool to track the
pre-, intra-, and postoperative protocols
of surgery, alongside metrics such
as rate of return, length of stay, direct
cost, and complications. They have
openly shared research, and when a
particular process, practice, or method
is shown to produce the outcome expected,
it becomes a best practice.
Data mining
As an academic medical center, VCU
Health has access to a wealth of information.
Our health record spans multiple
cities across Virginia, and we house 60
terabytes of records from handwritten
forms, equipment, and vendors across
our many campuses. We have more
than 60 trillion bytes of information. For
perspective, if each byte represented
one grain of rice, VCU Health would
house 120 container ships full of rice.3
Deciphering which data are available,
in what format, and how to leverage
that data in a meaningful way is
often challenging. Although analysts can
quickly locate patient demographics,
appointment information, and labs, assembling
these buckets of data into
useable information is an arduous task.
We first look at our current-state operations
and the principles outlined by
the ERAS Society (see " Enhanced Recovery
After Surgery: The new standard
for perioperative care, " OR Manager,
October 2019, 1, 14-17). Using those
as a guideline, along with our medical
experience and knowledge of our patient
population, we identify key performance
indicators (KPIs) and attribute plausible
causation to each. Then, we begin to
build a dataset alongside our clinicians
to support identifying, monitoring, and
controlling these trends.
It is well known that " establishing
KPIs and opening transparency is the
first step to enhance accountability, up
and down the organization. " 4 We ensure
the KPIs align with our clinical and business
objectives and are relevant to our
mission. Once we have identified which
KPIs are valuable, and who owns which,
we determine a refresh cadence and use
the Peter Drucker mantra: " If I can measure
it, I can track it. If I can track it, I can
report it. If I can report it, I can explain it.
If I can explain it, I can predict it. If I can
predict it, I can prevent it. " 5
We publish our KPIs and make them
accessible to clinicians using Tableau.
Leaders can then decide whether to seek
improvements in compliance or adoption,
scale up certain practices or behaviors,
or possibly even roll back protocols.
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OR Manager - April 2020

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