Patients are the winners after a Lean Six Sigma green belt project at Texas Health Alliance implemented new processes around colorectal procedures.
Ta’Tanisha Eldridge, Perioperative Services director, and Nolan Martin, Pharmacy director, tackled the project to improve the patient experience. Ta’Tanisha said Texas Health Alliance did not have a formal protocol for colorectal procedures, specifically colon cancer and diverticulitis. After receiving guidance and feedback from a multidisciplinary team, she and Nolan researched national and local benchmarks and compared them to practices at Alliance. Texas Health Dallas and Texas Health Plano are using similar practices, called Enhanced Recovery after Surgery, or ERAS, and contributed to the work.
Nolan said the goal was to develop a high reliable pathway, or ERAS, that can provide cost reduction, enhance patient outcomes and improve patient satisfaction and safety.
ERAS practices impacted four areas of the hospital: surgical supplies, pharmaceutical supplies, clinical nutrition and perioperative services. Changes were implemented at the onset of patient treatment to help increase patient education and engagement. “The use of pre-surgery Ensure drinks and multimodal pain management were key in early mobilization on post-op day zero, which led to decreased length of stay,” Nolan said.
Ta’Tanisha said their work began in late 2017 and yielded 25 baseline ERAS patients, which provided clinical data to support project goals. “They continue to monitor all ERAS patients undergoing elective colorectal surgeries for sustained success and want to ensure further adjustments are not needed over time,” Ta’Tanisha said. “But we also designed this pathway to be replicated for other surgical procedures, such as those offered in OBGyn, and we are looking at how to proceed from here. Some changes may need to be made, but the foundation is there.”
Ta’Tanisha and Nolan are currently collaborating with key system stakeholders to develop a system order set in Epic to be shared with other hospitals.
Project achievements included:
~ reduced baseline surgical site infections from 7.81 percent to 0 percent
~ decreased length of stay from 7.11 to 3.83 days
~ decreased the colorectal surgical patient average opioid usage (measured in morphine milligram equivalents) from 187 mg to 127 mg