|The Magic of Interprofessional Collaboration|
|Chris Meister, OTD, MBA, ORT/L, FACHE|
Without a doubt, our patients deserve the very best from all of us. In a large, complex health care system it is sometimes difficult to determine what that means. In my opinion, people from different professions, specialties, and departments coming together to implement best practices is a great example of such an effort.
Hawai’i Pacific Health has been part of a national initiative for several years now, focused on improving outcomes for surgical patients. The Agency for Healthcare Research and Quality (AHRQ) is leading an effort to incorporate Enhanced Recovery After Surgery (ERAS) guidelines into our daily work. The goal is to standardize the care pathway per type of procedure so each patient can take advantage of a carefully crafted bundle of best practices throughout the episode of care. By offering care that is proven to improve outcomes, we are also addressing cost of care and patient experience. Regardless of the type of procedure in question, there are common principles that facilitate early recovery.
- Best practices to prevent harm, such as DVT prevention and pre-operative bathing.
- Patient activation and engagement in care.
- Ensuring the patient is adequately prepared for surgery.
- Regional anesthesia and multi-modal pain management.
- Avoidance of drains and catheters.
- Early mobility after surgery.
- Early oral intake after surgery.
You may be thinking that this sounds pretty straight forward – nothing really new or controversial. You are right about that. The challenge is not in agreeing with the outcomes research, but rather to create work flows that ensure we practice to this standard for every patient, every time.
We have seen great examples throughout Hawai’i Pacific Health of surgeons, anesthesiologists, hospitalists, emergency room physicians, nurses, therapists, case managers, operating room leaders, dieticians, pharmacists, service line leaders, quality department leaders, surgical clinical reviewers, executives, staff educators, peri-op nursing staff, clinic leaders, and others coming together to work towards a common goal of better outcomes.
Some of the work done this year, which has resulted in improved outcomes:
- New, comprehensive education books for colorectal and orthopedic surgery patients.
- New order sets incorporating best practice standards of care.
- Creating an application that pulls information from various IT system and enables leaders to see the progress being made, both process measure and clinical outcome data.
- Staff and provider education on new policies, protocols, and pathways.
- Collaboration with IT to make sure as much of the change is hard coded and automatic, such as pre-selecting certain items on order sets or flagging patients as an ERAS patient in the EHR.
Examples of clinical outcome improvement:
- Urinary catheter use decreased by 63% for patients with elective hip or knee replacement
- Average morphine milligram equivalents per day decreased by 17% for patients with elective hip or knee replacement
- Use of multi-modal pain management strategies increase by 31% for patients with hip fracture
Though this particular initiative with AHRQ is just for adults at the moment, the team at Kapi’olani Medical Center for Women and Children has worked on a similar effort for the past couple of years. From a bone & joint perspective, we have focused on patients who undergo hip preservation surgery and the patients who have surgery for scoliosis, often teenagers. In the same fashion as already described, an interprofessional team met regularly for a period of time to research best practices, discuss how to best integrate them into our work flows, and implement these changes through staff education and standard protocols. The result has been patients who feel better prepared for surgery, have better pain control, are able to mobilize quicker, and go home sooner.
The number one ingredient for success in these types of initiatives is a motivated work group, often led by a physician champion or other clinical leader who is passionate about improving the patient journey.
Another rewarding part of the journey with ERAS has been to see the hospitals in the State of Hawai’i collaborate – sharing data, discussing best practices, learning from each other. It is a wonderful thought that Aloha will ultimately contribute to safer care and better outcomes.