The Role of the ERAS® Coordinator
Kelsey Terrones, CRNP
Greater Baltimore Medical Center
Presented by the Enhanced Recovery Shared Interest Group
As most clinicians and health organizations can attest, incorporating and implementing new evidence-based practice changes almost always involves overcoming some challenges and obstacles on the road to success. Common obstacles are often provider and upper management endorsement as well as financial resource and time allocation. Here, I will examine the effect of these obstacles on the creation of the Enhanced Recovery After Surgery (ERAS) Coordinator role at Greater Baltimore Medical Center (GBMC).
In August of 2016, Kara Douglas, CRNA alongside Dr. John Kuchar created and implemented the ERAS program, initially for the colorectal service line, at GBMC. In September 2016, I returned to GBMC as a nurse practitioner in GBMC’s Pre-Surgical Testing Center (PTC). My role included pre-operative patient care coordination and diagnostic testing. In June 2017, I was selected to join GBMC’S ERAS team as the ERAS Coordinator. This position created to help promote the success of our ERAS team led by Kara Douglas, MS, BSN, CRNA, ERAS Director, and Dr. Kuchar. This has been an incredibly challenging and rewarding opportunity as it is currently remains a dual-role position. The main challenge in this role is that I must balance my time between seeing patients for pre-operative evaluations as well as performing my duties as ERAS Coordinator.
Some of the ERAS Coordinator responsibilities I hold include: providing ERAS education for the patients pre-operatively, rounding on the hospital ERAS patients post-operatively, collecting and compiling patient data pertaining to our ERAS protocol adherence and evaluating patient outcomes. Lastly, Kara and I conduct at least one or two weekly meetings with key stakeholders from upper management, finance as well as our multidisciplinary team including EPIC analysts, physician/surgeon champions, nurse champions and nurse managers, physical and occupational therapies, dietitians/nutritionists and the Quality Department. This allows us to continue to advance our program and address problems as they arise.
When the patients come through the PTC for ERAS education, they receive an incentive spirometer, one or two bottles of Ensure Pre-Surgery (depending on the patient’s co-morbidities), a bottle of hibaclens (CHG) scrub and a folder of written instructions for these items as well as an overview of what to expect in the hospital and the purpose of the ERAS program. Unfortunately, it has been a challenge to see all of the patients undergoing ERAS procedures as not all choose to come through the PTC for the education session that lasts only 10-15 minutes and this is not mandatory education by the surgeons or GBMC.
ERAS in-patients are rounded on daily to collect key data points to evaluate compliance of our ERAS protocol as well as patient outcomes. Key data points include but are not limited to: patient ambulatory status, diet, time of return of bowel function, time of foley removal, pain evaluation and narcotic consumption.
Currently, GBMC is part of the improving surgical care and recovery (ISCR) but otherwise, does not utilize any formal system or platform for data collection/extraction and analysis. I am currently extracting all the various data points we are monitoring through individual chart audits in conjunction with patient rounding. This is a time consuming and labor-intensive data extraction and analysis process; however, we are examining various data capturing platforms from the ERAS societies to determine which would be the most beneficial platform for our institution. We have also been working closely with our EPIC team (our electronic medical record system) to develop audit features that can facilitate and expedite some of the information I am auditing from the individual charts.
GBMC’s ERAS program has been incredibly successful and has grown under the direction of Kara and support of Dr. Kuchar. This is largely due in part to their ability to network within and outside of our institution, as well as the work of our multidisciplinary team, endorsement and support from staff and upper management and personal and professional time investment. Many of the obstacles, namely time, resource allocation as well as coordination of the team, have been our hardest obstacles to overcome. For any institutional considering creating an ERAS program, based off our experiences with creating our ERAS program it is critical first and foremost that endorsement and support for your program is obtained from the institution’s key stakeholders and upper management. Lastly, proper time and role delineation should also be addressed and allotted as this will promote and ideally expedite proper expansion of the program to be instituted.