The use of an Enhanced Recovery After Surgery (ERAS) approach among hip fracture surgery patients allowed them to return home faster and return to normal activities sooner, according to researchers.
The findings were presented recently at the American College of Surgeons 2018 Quality and Safety Conference.
Upon reviewing a site report from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), researchers at Langley Memorial Hospital, Langley, BC, Canada, discovered that patients who underwent hip fracture operations had higher morbidity and mortality rates and a higher prevalence of delirium than the national average.
“We knew we could do better, because we had already successfully applied the principles of ERAS to our colorectal patient population,” says Lila Gottenbos, RN, BScN, a Surgical Clinical Reviewer at the hospital, who led the research, according to a media release from the American College of Surgeons.
To address these challenges, a multidisciplinary team of nurses, surgeons, and clinicians adapted an enhanced recovery approach to meet the specific needs of their patients with hip fractures.
For example, this population is at greater risk for delirium, a condition that often prolongs hospital stays and results in higher complication rates. Thus, an intervention was implemented to assess these patients for delirium preoperatively and on a regular basis for 5 days after their operations.
“With enhanced recovery, mobility is one of the foundational process measures, but with our intervention, we were even more aggressive with mobility, specifically making sure that our patients were getting up within 24 hours of surgery and to a chair to eat at least two meals within 2 days after surgery,” Gottenbos states.
These practices were applied to every patient who had hip fracture operations from January 2016 to the present.
According to the study, this new care approach cut nearly 2 days off the average hospital stay, without increasing the readmission rate.
Additionally, over a 2-year span the mortality rate dropped by more than 50%—from 9.7% to 4.2%. The rate of pneumonia—a common complication in high-risk patients after an operation—fell nearly 50%. Furthermore, the morbidity rate decreased by 33%, per the release.
Patients and families also received preoperative counseling about what they should expect as part of the operative and recovery experience. Study results also showed that patients were less likely to require a transfer to a nursing facility.
Overall, this new enhanced recovery approach has raised awareness about caring for a vulnerable adult population, the release continues.
“The processes we instituted for our fractured hip patients have had a huge positive ripple effect,” Gottenbos comments.
“We have seen a great shift in the way staff think about patients, caring for them with a more holistic focus, and thinking about the path to discharge as soon as the patient walks in the front door. The focus is on getting patients home safely, quickly and in better condition than when they came to us.”
Langley Memorial is now looking to expand this ERAS approach to other patient populations.
“It’s very rewarding to see that these high-risk patients can be successfully treated and sent home earlier,” Gottenbos concludes. “We are very confident that the work we are doing gives people a better chance to return to baseline functioning and get back to their normal lives.”
[Source(s): American College of Surgeons, EurekAlert]