The Ambulatory Care Clinic Coordinator’s Role in Preventing Surgical Complications: Utilization of the Enhanced Recovery After Surgery (ERAS) Program in an OBGYN Clinic

Surgical outcomes have impact on both patient health and CMS reimbursement. Preventing poor outcomes such as surgical site infections (SSIs) and readmissions are important tasks that do not only occur in the operating room. The general OBGYN department implemented the enhanced recovery after surgery (ERAS) best practice guidelines and utilized nursing care coordinators (CCs) in the clinic to impact patient outcomes. A pre-op education program was developed by GYN Nurse CCs based on best practice and hospital guidelines to prepare patients for surgery. The education is provided by a CC via a 30-minute telehealth or in-person appointment and includes what to expect with their procedure, pre-op instructions, and post-op mobility. As part of the education, the patient is encouraged to participate in a rehabilitation program. They are also introduced to pre-op nutrition and CHG bathing which are key elements of ERAS.

Several PDCA cycles have been completed to get to current state. Current state: once the surgery is deemed necessary, the provider places the case request. The patient is automatically added to a report that the GYN CCs manage. The report is pulled daily. The GYN CC places the pre-procedure orders and ERAS pathway. Once the surgery is scheduled, the GYN CC is notified to contact the patient and schedule their pre-op, pre-op education, post-op, and COVID testing appointments.

Initially, the patient was immediately called by the CC to set up their education appointment and then later called by the surgery scheduling team. The physician’s nurse would be notified to schedule the pre-op, post-op, and COVID testing. After this process had occurred for several patients, a better process was identified. The process was updated to the current state where the CC calls the patient to schedule their appointments all at once. This simple change improved patient experience and alleviated work from the nurse team that could easily be absorbed by the CC. We found that multiple calls to the patient from different people led to fatigue, frustration, and a sense of being overwhelmed for the patient; this simple change alleviated that.
Some patients provided immediate feedback regarding their pre-operative education appointment. One patient stated, “this education was very helpful and helped me to feel prepared.” Another stated, “Usually when you decide to have surgery, you walk out of the doctor’s office feeling nervous and unsure and like you are just floating…The education [the CC] provided helped me to feel self-assured and knowledgeable.” In addition to providing education and setting up appointments, the CC has become the primary source of contact for the patient as they prepare for their surgery which allows each patient to become familiar and comfortable with a trusted member of their health care team.

Future state will include post-op follow up calls. Data is being collected regarding readmissions and surgical site infections and will be analyzed monthly. The ERAS program started in August of 2020, and to date we have provided care to over 100 patients.