Enhanced recovery after surgery clinical pathway implementation effect on postoperative ambulation

Abstract

Problem & Purpose: Enhanced recovery after surgery protocols have been shown to decrease postoperative complications including venous thromboembolism, delayed gastric emptying, and ileus. In a surgical telemetry unit in a suburban community hospital, the average time to first ambulation for patients undergoing pancreatectomy is postoperative day three. Barriers to early ambulation include lack of patient education and lack of standardized goals. Although early postoperative mobility is a vital aspect of postoperative care, enhanced recovery guidelines have limited information about specific protocols or daily goals. The purpose of this project is to implement preoperative patient education and a clinical pathway to encourage early ambulation in patients undergoing pancreatic resection. Methods: Implementation started in September 2021 and continued for 15 weeks. Preoperative education was provided in both verbal and written formats for those patients who met the inclusion criteria. In the surgical unit, the nursing staff received education on the clinical pathway and standardized documentation. The nursing staff then utilized the clinical pathway tool daily to encourage ambulation. Data was collected from the electronic health record on pre-operative education, date of first ambulation, and length of stay. Results: Preimplementation data showed that while the average time to first ambulation was postoperative day three, there was a wide variation from postoperative day one to postoperative day eight. After the implementation phase, seven patients met inclusion criteria. Four patients received verbal and written education. All seven patients ambulated for the first time by post-operative day two, and length of stay for all patients was at or under seven days. Conclusions: Based on the postimplementation data, patients undergoing pancreatic resection ambulated earlier after surgery and had decreased length of stay.