A. A. Henderson1, K. Staveley-O’Carroll2, E. Kimchi2, A. Dickinson3, K. Clements4, M. Wakefield1, K. Murray1 1University Of Missouri,Division Of Urology-Department Of Surgery,Columbia, MO, USA 2University Of Missouri,Division Of Surgical Oncology-Department Of Surgery,Columbia, MO, USA 3University Of Missouri,Department Of Health Management And Informatics, University Of Missouri,Columbia, MO, USA 4University Of Missouri,Center For Health Care Quality,Columbia, MO, USA
Introduction: Historically, patients undergoing radical cystectomy (RC) for bladder cancer have long hospital stays often characterized by high complication and readmission rates. This presents a unique opportunity to improve quality and standardization in overall care. In this report we describe our hospital supported and surgery organized initiative to create an enhanced recovery protocol after RC and assess its effects on patient outcomes.
Methods: A comprehensive plan was developed using a collaborative, multi-disciplinary approach utilizing hospital and departmental administration, urologists, anesthesiologists, nursing, pharmacy, nutrition, wound care, physical therapy, resident physicians, patient experience representatives, electronic medical record personnel, and Health Administrative fellows. A reporting system was organized to prospectively evaluate protocol outcome measures.
Results: A project manager and advisor were identified from the Health Administration fellowship and Quality Improvement office of the University, respectively. Key stakeholders were invited to a standing meeting that occurs biweekly. Additional needs were identified, leading to a total invite list of 53 participants. To date, 14 meetings have occurred with an average of 26 participants attending each meeting. Ten leaders visited another tertiary referral center to learn about the implementation of enhanced recovery at the institution. New educational packets were devised in addition to an electronic order set pathway and hospital-wide uniformed education including a grand rounds showing leadership support. It took 6 months from idea inception to go-live with the first patient on protocol (Fig. 1). To this point, every patient undergoing RC is being placed on this enhanced recovery pathway.
Conclusion: RC is a costly procedure from the perspective of patients and hospital systems, which presents an opportunity for meaningful improvement. The production of a uniform service specific pathway requires collaboration, organization and dedication from many individuals. We plan to continue to assess our protocol adherence, patient outcomes and satisfaction, and make appropriate changes.
