Preoperative Education Regarding the Enhanced Recovery After Surgery (ERAS) Guideline for Colorectal Surgical Patients: A Quality Improvement Project

BACKGROUND: Advancements in colorectal surgeries can be attributed to the adoption of the Enhanced Recovery After Surgery (ERAS) clinical guideline, which is a system of perioperative interventions bundled together cohesively to enhance a patient’s surgical experience, especially their post-operative recovery. One of the first interventions that initiates the ERAS process is the delivery of patient education before surgery. However, there are currently no standardizations on the kind of content or method of delivery for this education. PURPOSE: This Quality Improvement (QI) project determined the effects of a private, inperson, educational program discussing in detail the ERAS guideline adopted by their treating facility and the patient’s active role in the recovery process. An enhanced quality of recovery for these colorectal surgical patients was evaluated by measures of an early return to normal activities of daily living (ADLs), symptom incidence, levels of anxiety, and patient satisfaction when compared to patients who receive usual care. METHODS: A multivariate, repeated measures design was used, which followed the Plan, Do, Study, and Act (PDSA) model. The sample consisted of ten participants who were scheduled for colorectal surgery at a community medical center. Participants were given code numbers where odd numbered participants received the educational intervention and even numbered participants represented the usual care, control group. After informed consent, a Demographic and Clinical Data form was completed for each participant. The Quality of Recovery40 (QoR-40) questionnaire was administered to the intervention and usual care groups at two time points: upon hospital discharge and one week following hospital discharge. Descriptive analysis was used to identify trends in the Demographic and Clinical Data forms, while changes in the scores on the QoR-40 questionnaires was measured by independent and paired t-tests. RESULTS: A two-tailed paired t-test analyzed the difference in mean scores of the intervention group on Discharge Day and One-week Post-Discharge, revealing statistical significance with a t-score (5) = 3.9198 and p-value = 0.0173. Another two-tailed paired t-test analyzed the difference in mean scores of the control group on Discharge Day and One-week Post-Discharge, revealing statistical significance by a t-score (5) = 2.9994 and a p-value = 0.004. However, completing a one-tailed independent t-test on Discharge Day scores between the intervention and control group revealed no statistical significance as demonstrated by t-score (5) = 0.6551, and a p-value = 0.5308 (p>0.05). Another one-tailed independent t-test on One-week Post-Discharge scores between the intervention and control group revealed no statistical significance as demonstrated by a t-score (5) = 1.2421, and a p-value = 0.2494. DISCUSSION: The results of this QI project indicate that for elective colorectal surgical patients, education regarding the ERAS guideline is not required to enhance their surgical recovery, measured by an early return to ADLs, decreases postoperative symptoms, decreased levels of anxiety, and overall increased patient satisfaction. Further research is needed to study the effects of different preoperative educational material to determine what content is most influential on patients’ surgical recovery.