ERPs for colorectal surgery not easily implemented

Editor's Note

This study led by American College of Surgeons researchers finds that most hospitals that implemented an enhanced recovery program (ERP) for colorectal surgery had difficulty improving process compliance.

Researchers evaluated improvement uniformity among 151 hospitals participating in an 18-month implementation protocol for 6 ERP process measures (oral antibiotics, mechanical bowel preparation, multimodal pain control, early mobilization, early liquid intake, and early solid intake).

Of 906 opportunities for process compliance improvement (151 hospitals x 6 process measures), 663 were included in the study:

• Minimal improvement (0 to 20% increase in compliance) occurred in 52% of opportunities.
• Substantial improvement (more than 20% increase in compliance) occurred 20% of the time.
• Worsening compliance occurred in 28%.
• Of the 6 processes, multimodal pain control and use of oral antibiotics improved the most.

The researchers concluded that contrary to published ERP literature, the majority of study hospitals had difficulty improving process compliance. Attention needs to be directed towards improving ERP adoption across all hospital types and cultures.