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READY TO GO HOME? PATIENTS' EXPERIENCES OF THE DISCHARGE PROCESS FOLLOWING CARE IN AN ENHANCED RECOVERY AFTER SURGERY (ERAS) PROGRAM FOR COLORECTAL SURGERY
Daniel Jones*3,1, Reilly Musselman2, Emily A. Pearsall3,1, Marg McKenzie1, Harden Huang1, Robin McLeod3,1
1Surgery, Zane Cohen Clinical Research Unit, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto , ON, Canada; 2Division of General Surgery, The Ottawa Hospital (Civic Campus), Ottawa, ON, Canada; 3Surgery, Department of Surgery and Institute of Health Policy Management, University of Toronto, Toronto , ON, Canada
OBJECTIVE: Pre-operative education is an important component of an ERAS pathway. However, discharge planning and education is equally important since many patients have a shortened length of stay and need information in order to self-manage post-operative symptoms as well as be able to identify when they require assistance. Thus, we surveyed patients who were managed in an ERAS pathway to understand their education needs and deficiencies prior to discharge.
METHODS: Between 2012-2014, an ERAS pathway was implemented for patients having elective colorectal surgery at Mount Sinai Hospital, Toronto, Canada. Demographic and outcome data, including 30 day follow-up data, were collected prospectively on all patients. Following discharge, a survey containing multiple-choice questions, preference ranking, and open-ended and close-ended questions was created to ascertain patient informational and follow-up needs prior to discharge. Free-text responses were analyzed through a grounded theory approach.
RESULTS: Of 554 patients who were part of the iERAS implementation program, 496 patients were mailed surveys, of which 219 (44.2%) patients completed the survey. Most patients (88%) stated they received information prior to discharge and 94% said it was provided by a health care provider. While 93% of respondents stated they were satisfied with the information, many indicated they wanted more information on wound problems (59%), fever (38.4%), nausea/vomiting (56.6%), abdominal pain (43.4%), bowel function (49%) and ostomy problems (35.6%). Major concerns raised by respondents related to lack of adequate post-operative information on how to mitigate complications while at home, more details on what to expect and information on who to contact should problems arise. As described by one patient: “There should be clear information written on impact, length of recovery and what to expect in your day to day experience”. Patients reported being advised to go to the emergency room (68.4%), call their surgeon (53.4%) or call the surgical nurse (30%) if problems arose. The latter was valued and one patient said: “A telephone number for follow-up concerns would have been helpful for me”. Despite 54.3% having the telephone number of the surgical nurse, only half of them contacted her.
CONCLUSION: Improved post-operative education for surgical patients prior to discharge within an ERAS program is required to facilitate patient-centered discharge planning. Such interventions may help to decrease unplanned hospital visits during the immediate post-discharge period.
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