Enhanced Recovery Pathway

The evidence-based colon and rectal surgery enhanced recovery pathway (ERP) went live on February 14, 2012. Hospital length of stay and patient outcomes were noticeably improved soon after the implementation of this multi-disciplinary protocol. Many patients have recovered and been discharged on postoperative day 2, and many robotic patients on postoperative day 1. A collaborative effort to include specialists in Nutrition, Case Management, Social Work, Home Care, Patient Care Unit Nursing, Anesthesia, Pharmacy, and other related disciplines emphasizes preadmission education, carbohydrate loading, state-of-the-art multimodal pain management, early feeding, early mobilization, and comprehensive discharge planning as components of the protocol responsible for success of this program.

Dr. Cleary was awarded a $102,000 grant from the Blue Cross Blue Shield Foundation of Michigan (BCBSM) to fund this Enhanced Recovery Pathway. This research project was published in 2016 and demonstrated that the program decrease hospital LOS by 2 days.

Subsequent studies by our group showed that readmissions are significantly decreased with ERP upgrades that include a mobile phone app that delivers preadmission push notification patient reminders and postoperative questions about common complications that patients respond to and that are monitored 24/7. The ERP also includes a pharmacist-led multimodal pain management strategy with emphasis on non-opioids, and unlimited high-level standardized and regimented post-discharge clinic visits for ileostomy patients.