In an effort to improve colorectal surgical outcomes, Maimonides Medical Center developed a team of leaders and frontline staff who implemented an action plan that included four evidence-based processes using the Plan, Do, Study, Act methodology.
The first process implemented was the Enhanced Recovery After Surgery (ERAS) protocol, which was placed in the hospital’s computer system and developed into a brochure for pre-admission patient education. Second, the institution adopted the advanced colon bundle recommended by the American College of Surgeons to decrease the surgical site infection rate for colorectal surgeries. The third process implemented was the Medical Early Warning System. The fourth patient care initiative added to the program was the use of Postoperative Co-management of colorectal surgical patients by internal medicine hospitalists. This program includes frequent rounding by internists to optimize the patient’s post-operative course, particularly those with high-risk medical co-morbidities. The co-managers are part of the primary care team and communicate directly with the surgeons.
Since implementation of these processes, there have been notable downward trends in colorectal surgical outcomes, including decreases in the odds ratio for colorectal mortality, overall colorectal morbidity, and colorectal returns to the operating room.