Real time compliance monitoring with NSQIP: Successful method for enhanced recovery pathway implementation

Background Compliance with Enhanced Recovery Pathway (ERP) variables improves clinical outcomes. The National Surgery Quality Improvement Program (NSQIP) database includes ERP variables. We wish to determine if modifying NSQIP workstation workflow would increase compliance with ERP and improve outcomes following gastrointestinal surgery. Methods NSQIP ERP variables were abstracted from patients enrolled in ERP and undergoing elective surgery within 2 weeks following surgery. The compliance was monitored and shared with a multi-disciplinary group of providers bi monthly. Clinical outcomes and patient experience was measured as a surrogate for successful implementation. Results 71 patients were entered into ERP and compared to 98 baseline patients (non-ERP). Over eight months, compliance improved from 67% to 85%. However, compliance remained lower among postoperative variables (52% - 82%). The median length of stay was educed by 2 days (p = 0.01). There was a trend towards reduction in readmissions, hospital acquired conditions, mean direct variable charge and an improvement in patient experience (Press Ganey) outcomes among the ERP patients compared to non-ERP patients. Discussion Real time monitoring of NSQIP ERP variables provides a structure for ERP implementation. As more programs engage in NSQIP, this workflow may become a key means for improving patient outcomes and safety.