Multidisciplinary Review Committee Oversight Improves Adherence to Newly Implemented Thoracic Enhanced Recovery after Surgery Protocol

INTRODUCTION: Benefits of thoracic Enhanced Recovery After Surgery (ERAS) programs have been well described in the literature. After implementing a thoracic ERAS program, we sought to determine if compliance review during quality improvement meetings improved protocol adherence. METHODS: A multidisciplinary committee developed and implemented a thoracic ERAS protocol for anatomic lung resections across 6 hospitals within our health system. Adherence data was tracked for 3 months after initiation of the ERAS protocol, a quality review committee meeting was held to review compliance barriers, and 2 additional months of compliance data were recorded. We examined compliance changes to 5 key protocol elements. Pathway elements deferred due to mindful deviation were excluded. Chi-square and Fisher’s exact tests were used to compare categorical data where appropriate. RESULTS: We included 81 patients, 53 patients before the quality review committee meeting and 28 after. There were 405 compliance opportunities; 68 (17%) were excluded for mindful deviation, leaving 337 (83%) for inclusion. Overall adherence improved after the quality review committee meeting (Table; 53% vs 84%, p < 0.001). Compliance to avoiding intraoperative urinary catheters, placing chest tubes to water seal in post-anesthesia recovery unit, early chest tube removal, and postoperative multimodal pain regimen use improved after the quality review committee meeting (all p < 0.05). Use of preoperative pain bundles improved, but this did not reach statistical significance (87% vs 96%, p = 0.25). CONCLUSION: Conducting a thoracic ERAS quality review meeting to identify compliance barriers significantly improved protocol adherence. This experience can be extrapolated to other institutions implementing ERAS protocols. Table. - Adherence to Targeted Enhanced Recovery After Surgery (ERAS) Elements Before and after the First Quality Review Committee Meeting Adherence item Pre-meeting cohort adherence Post-meeting cohort adherence p Value Preoperative pain bundle given 45/52 (87%) 26/27 (96%) 0.25 Intraoperative indwelling urinary catheter avoided 5/33 (15%) 22/27 (81%) <0.001 Chest tube placed to water seal in PACU 4/29 (14%) 9/16 (56%) 0.005 Early chest tube removal 21/52 (40%) 15/21 (71%) 0.02 Use of opioid sparing multimodal pain regimen 39/52 (75%) 28/28 (100%) 0.002 Overall 114/218 (53%) 100/119 (84%) <0.001