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A System‐Wide Enhanced Recovery Program Focusing on Two Key Process Steps Reduces Complications and Readmissions in Patients Undergoing Bowel Surgery

Loftus, Terrence J.; Stelton, Susan; Efaw, Brett W.; Bloomstone, Joshua

The Journal for Healthcare Quality (JHQ): May/June 2017 - Volume 39 - Issue 3 - p 129–135
doi: 10.1111/jhq.12068
Original Article

Abstract: Enhanced recovery programs (ERPs) can improve outcomes following bowel surgery, but implementing an ERP across a large healthcare system remains challenging. In this study, a simplified ERP that focused on two process steps, early and frequent ambulation and early alimentation, was evaluated to determine its impact on outcomes. Data were collected on 5,000 adult patients undergoing elective small and large bowel operations over a 3‐year period. Complication, readmission, and mortality rates were evaluated before and after ERP implementation. A composite score was calculated based on the successful completion of the two process steps. Following implementation, there was a 35.1% increase in the composite score, which was associated with significant (p < .05) reductions in overall complications, gastrointestinal complications, pulmonary complications, and readmissions. A system‐wide ERP focusing on early and frequent ambulation and early alimentation is associated with decreased complications and readmissions in adult patients admitted for elective small or large bowel operations.

For more information on this article, contact Terrence J. Loftus at

The authors declare no conflict of interest.

© 2017 National Association for Healthcare Quality
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