Shuting Guan
Royal Preston Hospital, UK
Title: A quality improvement project assessing adherence to enhanced recovery after surgery of intensive care unit in Royal Preston Hospital
Biography
Biography: Shuting Guan
Abstract
Aim: This audit aims to assess adherence to the Enhanced Recovery After Surgery (ERAS) pathway in the Intensive Care Unit (ICU) at Royal Preston Hospital (RPH). Results are compared to the standards set by the ERAS Society and the National Institute for Health and Care Excellence (NICE) regarding early mobilisation, oral intake, and cessation of Intravenous (IV) fluids. Further investigation of barriers preventing compliance was also explored and discussed in the recommendations for improvement.
Methods: Retrospective data collection of elective surgical patients during March and April 2022 were analysed and compared. A re-audit was performed to assess effectiveness following a week of re-education of nursing staff and doctors. An additional survey was also conducted amongst healthcare professionals to evaluate adherence and identification of difficulties for ERAS implementation.
Results: Numerous barriers to adherence were identified including patient, structural, cultural, and technical. Staff shortage, inadequate pain management, ambiguous plans, and lack of equipment are the main obstacles identified. Although improvements were seen in early mobilisation and oral intake, fluid prescription compliance remains poor. Staff re-education had minor improvement in ERAS pathway documentation (0% to 33%). However, there is limited data and further audits are required.
Conclusion: Overall, a minimal increase in compliance was noted. However, the small sample size and time limit prevented significant improvement in adherence. Further work including the Implementation of recommendations, on-going re-education, and reaudits is required to fully appreciate the benefits of postoperative ERAS for ICU.