Title : From assessment to action: Evaluating and improving adherence to the Enhanced Recovery After Surgery (ERAS) protocol in elective colorectal patients
Abstract:
Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary perioperative care pathway that optimises recovery following colorectal surgery by reducing surgical stress, postoperative complications, and length of hospital stay. Adherence to ERAS recommendations is associated with improved clinical outcomes; however, compliance with individual protocol elements varies in routine practice. This audit evaluated adherence to the local ERAS protocol, based on ERAS Society recommendations, among patients undergoing elective colorectal surgery at a tertiary colorectal centre and identified areas for quality improvement.
Methods: A two-cycle audit was conducted with elective colorectal patients admitted to a single tertiary center. The first cycle (July–August 2024) included all patients undergoing colorectal surgery, and the second cycle (September–October 2024) followed a similar cohort. Interventions in the first cycle included redesigning the ERAS protocol poster and distributing it throughout key hospital areas. Additionally, a weekly email reminder was sent to the colorectal team, emphasizing the importance of referring patients to the ERAS pathway. In the second cycle, adherence to the ERAS protocol was reassessed with a focus on the effectiveness of these interventions.
Results: In the first cycle, 77% of patients were referred to the ERAS nurse on the operative note, and 62% were reviewed by the ERAS nurse on the ward. However, only 60% of these patients were seen within 24 hours post-operatively. On post-operative day 1, 77% of patients progressed to free fluids, and 50% were discharged by day 5. In the second cycle, 70% of patients were referred to the ERAS nurse, and 65% were reviewed on the ward, with 80% seen within 24 hours. Additionally, 65% of patients progressed to free fluids by day 1, and 50% were discharged by day 5.
Discussion: This audit identified several gaps in the implementation of the ERAS protocol, particularly regarding timely referrals and reviews by the ERAS nurse. The findings highlight the need for consistent adherence to the protocol to optimize postoperative care. As a result of the audit, a significant change was made: all elective colorectal patients are now automatically considered for the ERAS pathway, unless contraindicated. This ensures that each patient is reviewed by the ERAS team, thereby improving protocol compliance and care continuity.
Conclusion: Implementing the revised ERAS pathway, with a default referral for all elective colorectal patients, will enhance adherence to protocol guidelines. Regular review by the ERAS team promotes early mobilization, fluid management, and pain control, reducing postoperative complications and length of stay, and ultimately improving patient recovery and satisfaction.
