OR Manager - April 2020 - 23

Special Series: ERAS
SPECIAL SERIES
ers, clinical effectiveness staff, and
the clinical teams meet regularly, and
our educators help staff implement any
changes. Collaboration with information
technology staff also helps to facilitate
adoption of any new processes.
Staff are given access to further
drill into scenarios of interest, or see
relevant data behind the KPIs. These
early data points are shown as baseline
data and are the starting points
for decision making.
Evidence-based practice changes
Data analysis is our tool for discovering
trends and themes we might not
have otherwise known about. Using advanced
tools and systems, staff can
learn how the data from our clinics, surgical
teams, and procedures translate
into the clinical impact of our services
on patients.
In the past, VCU Health lacked the
tools to gauge whether providers were
ordering the same fluids, medication
doses, preoperative antibiotics, anesthetic
blocks, and prophylaxes for deep
vein thrombosis and postoperative nausea
and vomiting-and how patients
were responding to those aspects of
care.
Today, analysts connect the dots between
very different data sources to
create a narrative for how and where to
drive cultural organizational change.
For example, our recent research
has shown that acute kidney injury can
be decreased by minimizing intraoperative
fluid variation.
We have also studied compliance
with processes such as not administering
benzodiazepines to patients over
age 65 because of the strong correlation
between use of this drug and delirium
in older patients.
A few years ago, concern about rates
of surgical site infections in patients
undergoing colorectal procedures led to
data analysis that helped identify practice
changes that were needed. Education
was provided to implement best
www.ormanager.com
practices and standardize surgical care,
and ultimately infection rates were reduced.
Our use of intraoperative opiate
administration in our main and ambulatory
ORs decreased from 50% to 30% of
anesthetic cases.
Adopting ERAS for colorectal surgical
patients has lowered surgical site
infection rates, decreased direct costs
by $3,700 per case, and cut the rate
of 30-day inpatient readmissions by 4%.
At the same time, case volume has
doubled and complexity ratings (defined
by the case mix index) have increased
3% per year. (For details on protocol
changes, see " Providing cost-benefit
analysis for ERAS-related solutions, " OR
Manager, January 2020, 26-27.)
These results have led to expanding
ERAS protocols to other specialties
such as orthopedics, neurosurgery, bariatric
surgery, spinal procedures, and gynecologic
oncology. We anticipate they
will be adopted for all surgical specialties.
In addition, we have joint memberships
with other medical centers to
cross examine ERAS in emergency general
surgery and hysterectomy.
We have also explored whether patient-reported
allergies to penicillin or
other medications have prevented providers
from administering the optimal
antibiotics. We have seen evidence that
because patients noted they were allergic
to specific antibiotics, we administered
suboptimal antibiotics. Our latest
evidence shows that less than 2% of
patients who self-report a penicillin allergy
actually have that allergy.
Research is ongoing to determine
the risk of an adverse reaction to an
antibiotic versus the risk of developing
a surgical site infection.
Ensuring success
Much of our success is attributed to senior
leadership, as well as the availability
and flexibility of the information at
hand. Having the right data allows leaders
to make a case for practice change.
As healthcare providers become accustomed
to seeing their scores, they become
motivated to use ERAS protocols.
The next step is for leaders to use positive
reinforcement to continually achieve
the desired behaviors.
Cam Holmes, MBA, MS, is
business intelligence, office
of clinical effectiveness, at
Virginia Commonwealth
University Health System in
Richmond
Nancy Nguy, is service line administrator,
OR/PACU administration, at Virginia
Commonwealth University Health System
in Richmond.
Aubrey Cutchin, RN, MSN, is senior department
quality coordinator, office of
clinical effectiveness, at Virginia Commonwealth
University Health System in
Richmond.
References
1 Ljungqvist O, Young-Fadok T, Demartines
N. The history of Enhanced
Recovery After Surgery and the
ERAS Society. J Laparoendosc Adv
Surg Tech A. 2017;27(9):860-862.
2 Taurchini M, Del Naja C, Tancredi
A. Enhanced Recovery After Surgery:
A patient centered process.
J Vis Surg. 2018; 4:40. www.
ncbi.nlm.nih.gov/pmc/articles/
PMC5847857/.
3 Wellman D. What is big data? Published
online July 18, 2013. http://
www.slideshare.net/dwellman/
what-is-big-data-24401517.
4 Hammerquist J. Using data to drive
organizational change in healthcare:
Learning faster than the competition.
Becker's Hospital Review.
January 17, 2018. www.beckershospitalreview.com/healthcareinformation-technology/using-datato-drive-organizational-change-inhealthcare.html.
5
Stikeleather J. How to tell a story
with data. Harvard Business
Review. April 24, 2013. hbr.
org/2013/04/how-to-tell-a-storywith-data.
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Manager | April 2020
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OR Manager - April 2020

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