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The benefits of an enhanced recovery protocol (ERP) in colorectal surgery have been well described; however, data on the implementation process is minimal, especially in a resource-limited institution. The purpose of this study was to evaluate outcomes during implementation of a physician-driven ERP at a public-funded institution. We retrospectively reviewed all elective colorectal surgery during a transition from standard care to an ERP (implemented via a standard order sheet). Data regarding use of care plan, length of stay (LOS), and rates of postoperative complications and readmission were recorded. One hundred eleven patients were included in the study; however, complete use of the ERP after its introduction occurred in a total of 50 patients for a compliance rate of 60 per cent (95% confidence interval [CI], 49 to 70). Late implementation of ERP diet, analgesics, and activity were the most common process errors. Full application of the ERP reduced mean LOS by 3 days (P 5 0.002), and there was a trend toward decreased postoperative morbidity without an increase in readmission rate (P 5 0.61). Full implementation of an ERP for colorectal surgery faces many challenges in a resource-limited county institution; however, when fully applied, the ERP safely reduced overall LOS, which is important in cost containment.
DESPITE VARIATIONS in the framework, ERPs have been demonstrated to improve patient management through the reduction of surgical stress, organ dysfunction, and postoperative morbidity.1-4 Core elements of ERPs in colorectal surgery include thorough preoperative counseling of patients, preservation of gastrointestinal function, minimizing organ dysfunction, adequate pain control, and promotion of patient autonomy.4-8 The implementation of such evidencesupported practices has led to significant reductions in hospital stay from the standard 6 to 12 days seen with traditional perioperative regimens.9, 10 However, it is important to note that initiation of a fast-track protocol often requires a multidisciplinary approach and access to adequate resources.11 Involvement of anesthesiologists, surgeons, dieticians, and nursing teams among other sectors of the healthcare team is critical in the implementation of an ERP.4 This may prove difficult in a setting with limited resources and hospital staff. Although ERP implementation may reduce postoperative morbidity and length of hospital stay, wide acceptance of such programs have yet to be seen.12 The aim of our study is to evaluate the...