Development of a Flowchart for Enhanced Recovery After Surgery for Elective Colorectal Surgery

Abstract

Enhanced Recovery After Surgery (ERAS) focuses on the surgical patient with implementation of evidence-based pathways to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery in all phases of surgery (American Association of Nurse Anesthetists [AANA], n.d.). The purpose of this Doctor of Nursing (DNP) project was to develop a flowchart with preoperative and intraoperative recommendations for patients scheduled for elective colorectal surgery with the aim of determining feasibility for implementation into practice. A survey adapted from the FAME (feasibility, appropriateness, meaningfulness, effectiveness) quantitative survey tool consisted of Likert-type questions (n=6), demographic data (n=2), closed-ended question (n=1) and open-ended question (n=1) assessed feasibility of an ERAS chart designed by the principle investigator (PI). A private anesthesia group practicing at a 99-bed community hospital in Hawaii included a convenience sample of anesthesia providers (n=8) as the participants. The survey was sent to participant’s emails via SurveyMonkey with a 10-day time frame to respond. Participants who responded within the 10 days resulted in a 75% (n=6) response rate. Responses for overall quality of the guideline encompassing four questions resulted in weighted average Likert scores ranging from 3.67-4.17 resulting in an overall average of 3.1. Recommendations for use in practice resulted in most likely to use (40%, n=2), likely to use (10%, n=1), undetermined (10%, n=1) and least likely to use (40%, n=2). Findings determined the flowchart guideline quality was of average quality, half of participants would recommend, and half would not recommend this flowchart into practice. Future implications are to include a detailed decision tree for each area of recommendation and to include drug dosages to guide providers in more detail while caring for these patients.