In 2016, Carolinas Medical Center's Hepato-Pancreato-Biliary (HPB) Surgery Unit earned a national first
The HPB unit was awarded a certificate for implementing an Enhanced Recovery after Surgery (ERAS) program, marking it the first and only US center that has implemented specific guidelines that help patients recover quicker, receive more communications from their care team, and improve pain management, among other initiatives. “The ERAS award is an incredible source of pride for our team, considering our unit opened in June 2015,” says Garth McClune, RN, BSN, CCRN, nurse manager for Carolinas Medical Center's hepatobiliary specialty unit. “It will be one of those things that will push us to be better as time goes on.” Here, McClune reflects on the meaning of the award, and the work it took to achieve it.
What was the patient experience like for HPB patients prior to this unit opening in June 2015?
Once the patient was out of surgery, they would go to any number of surgical units here at the hospital. We did not have a dedicated unit for them. It was probably one of the most difficult situations for our physicians; they would say, "Where is my patient?" And they were walking approximately six miles a day to see their patients across 10 or more units. The level of care and consistency was another challenge for reliable patient outcomes.
Soon after the HPB unit opened last year, you learned about the ERAS Society. What did you do to meet the ERAS guidelines?
We’ve evolved our entire trajectory, from pre- to post-op:
- Before we implemented ERAS guidelines, patients’ course of stay would include more time in bed, and our communications with them were less consistent. They didn’t always know what to expect. Now, the first thing we do is pre-op education to make sure the patient understands their plan of care and what they’ll need to do in the days after surgery.
- During surgery, doctors implement many ERAS guidelines. We’ve minimized narcotics as a pain-management strategy, because narcotics can slow your gut down and result in more complications. We also have a strategy in place that every patient gets specific anti-nausea medicine. The entire experience is designed to reduce stress on the patient.
- Immediately after surgery, we have guidelines to follow for post-op days 1 through 4, which include more movement and less time lying in bed. Best of all, the patient, nurse and physician know what to expect.
What have the results been?
We’ve had great results, including:
- Reducing patients’ length of stay by 15 percent
- Reducing readmissions by 12 percent
- Creating consistent and improved patient outcomes
- Reducing the infection rate to 0 and sustaining it
What is one of the biggest differentiators for the HPB team?
Our team includes Kendra Tezber, RN, who is an ERAS-dedicated nurse. She ensures that not only do our nurses follow the ERAS guidelines, but our physicians do as well. She speaks with patients pre-operation, building that relationship prior to surgery, and goes in and checks on patients throughout the course of their stay, making sure they’re on course with the plan of care. I don’t know any other unit that has an ERAS-dedicated nurse.
