L. J. Kreutzer1, M. W. Meyers3, M. McGee1,3, S. Ahmad3, K. Gonzalez3, S. Oberoi3, K. Engelhardt1, K. Y. Bilimoria1,2,3, J. K. Johnson1,2 1Northwestern University,Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University,Chicago, IL, USA 3Northwestern Memorial Hospital,Chicago, IL, USA
Introduction: Enhanced Recovery Pathways (ERPs) improve post-surgical recovery and patient outcomes by reducing complications, decreasing length of stay, and improving patient satisfaction; however, hospitals underestimate the complexity of implementing a multifaceted intervention that requires high levels of patient participation pre- and post-operatively. Our goal was to evaluate patient perspectives during early ERP implementation and to address challenges patients face when preparing for, and recovering from, surgery.
Methods: As part of an in-depth, formative evaluation of an ERP for patients recovering from elective colorectal resections at a large urban tertiary care teaching hospital, we conducted semi-structured interviews with patients (n=9) from September 2016 to August 2017. At least two patients for each colorectal surgeon (n=4) participated in the interviews. Patients were asked if they knew they were participating in an ERP and about their pre-operative experience, level of preparedness, and expectations for surgery and post-operative recovery. Detailed notes were taken during each interview in lieu of audio recording to maintain patient confidentiality. We conducted thematic analysis using the constant comparative method to identify common themes.
Results: All patients approached for an interview agreed to participate. Patients interviewed were not able to identify specific benefits of ERP related to clinical outcomes but focused their comments on the patient-facing components of ERP. While all patients shared positive feedback regarding their care and post-operative pain control, their comments about ERP were inconsistent. Themes identified included expectations, preparation for surgery, the ERP patient education booklet, and inpatient experience (specifically diet, pain, and education). Patient views about the ERP patient education booklet provided prior to surgery ranged from useful – one patient strongly agreed and said she used the booklet to identify which activities to undertake each postoperative day to enhance her recovery – to inadequate or forgettable with some patients unable to remember receiving the book or not feeling that it fully answered their questions. Another common theme during the interviews involved patient confusion about the early feeding component of the protocol that allowed patients to eat on postoperative day 0.
Conclusion: Conducting patient interviews during the post-operative inpatient stay enabled us to explore patient understanding of an ERP. Patient activation is an important component of a successful ERP and careful attention is needed to engage patients in preoperative expectation setting and postoperative recovery. Multiple modes of education and augmented patient education materials may be more effective than a one-size-fits-all approach to facilitate engagement.