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Improving Lower Extremity Bypass Patient Outcomes

Enhanced Recovery After Surgery Implementation Project

Guthrie, Meredith P. MSN, RN, CNL; Xhaja, Anisa MHA, MSHQS; Beck, Adam W. MD, FACS

doi: 10.1097/NCQ.0000000000000431

Background: Care variation is associated with poor quality outcomes. Clinical practice guideline implementation is one method to decrease care variation and improve outcomes. Enhanced Recovery After Surgery (ERAS) is a clinical pathway encompassing best practices across the surgical patient care continuum.

Local Problem: The lower extremity bypass (LEB) population had high length of stay (LOS), readmissions, and surgical site infections.

Methods: A comprehensive and systematic project management process was utilized to implement the ERAS pathway in the LEB population with the help of an interdisciplinary team.

Interventions: Clinical practice guidelines were created to integrate ERAS elements into the LEB population care continuum. Patient education was revised or created to ensure standardized information was communicated to patients from consultation through discharge and early follow-up.

Results: Preliminary data show 4.57 mean LOS (n = 21) compared with the prior year's mean of 6.81 (n = 53).

Conclusion: ERAS pathway introduction to the LEB population is suggestive of improved outcomes based on preliminary data.

Departments of Quality, Patient Safety and Clinical Effectiveness (Mss Guthrie and Xhaja) and Surgery (Dr Beck), University of Alabama at Birmingham.

Correspondence: Meredith P. Guthrie, MSN, RN, CNL, University of Alabama at Birmingham Hospital, JT1407, 619 19th St South, Birmingham, AL 35249 (

The authors declare no conflicts of interest.

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Accepted for publication: July 8, 2019

Published ahead of print: August 26, 2019

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