St. Joseph Mercy Ann Arbor Gets Blue Cross Gant For Post-Surgery Advances

ANN ARBOR -- St. Joseph Mercy Ann Arbor has received $102,000 from the Blue Cross Blue Shield of Michigan Foundation to help fund the hospital's Enhanced Recovery initiative.

A collection of evidence-based patient care practices, the Enhanced Recovery initiative is a comprehensive 16-step standardized process to improve patient outcomes, decrease complications and shorten hospital length of stay after colorectal surgery.

"Although many doctors may be providing variations of some of the process in their own hospitals, put together this offers a standardized method across disciplines to treat patients from pre-surgery education to post-operative care to home care," said Robert K. Cleary, M.D., colorectal surgeon, Saint Joseph Mercy Health System.

"There have been attempts to implement this kind of protocol in other states but none are as comprehensive as ours," said Cleary. "You have to look to Sweden, where these protocols have transformed the care in the field of colorectal surgery over the last decade."

With the advent of health care reform in the United States and its focus on reducing readmissions, Cleary added, these standardized programs have real application value.

Pledged over a 24-month period, the grant money will provide a dedicated clinical research nurse assigned to the program to conduct pre-admission patient teaching and collect data on patient outcomes as part of a formal research study.

"This program was selected for its ability to improve health and healthcare and directly impact the quality of care in Michigan," said Ira Strumwasser, CEO and executive director of Blue Cross and Blue Shield of Michigan Foundation.

Although data is still being compiled, early results are encouraging. As a result of this protocol, a significant decrease in hospital length of stay has been seen at St. Joseph Mercy Ann Arbor from a national average of six days down to 4.7 days.

"Seventy-five percent of our colorectal patients go home on post operative day two," Cleary said.

The initiative was launched a year ago as part of the Colon and Rectal Surgery Service at St. Joseph Mercy Ann Arbor. The program was initially conceived to develop a new standard of care for patients undergoing colorectal surgery by bundling evidence-based best practices together in a team approach and breaking down silos that may exist between disciplines.

Representatives from each discipline -- including colon and rectal surgery, anesthesiology, pharmacy, nursing, nutrition, social work, physical therapy, enterostomal nursing, case management, home care and hospital administration -- were charged with determining best practices in each of their fields.

This multi-displinary approach resulted in a standardized protocol dictating how soon after surgery a patient should be sitting up, walking, eating, and weaning off pain medications to reduce complications.

"It's not just one thing, like the pain management algorithm or home care plans or glucose levels and temperature in operating room," Cleary said. "Ours is the first in this area to put it all together in a comprehensive care plan."

Surprisingly, some non-traditional practices were determined. such as drinking Gatorade on the way to the hospital prior to surgery instead of the more commonly accepted practice of drinking no liquids after midnight before the day of surgery.

"The use of carb-loading has been found to stimulate the intestines, resulting in improved recovery after surgery," Cleary said.

A key feature of the program is pre-admission patient education to prepare patients and their families for surgery and the hospital experience, enabling them to track their progress and participate in their own recovery.

Another benefit is that social work, physical therapy, case managers and home care know who their upcoming patients will be at the time of their initial office visit and can plan for them ahead of hospital admission.

While data collection is scheduled to be completed Feb. 14, 2014, the two-year study is already drawing interest from surgeons at other hospitals as well as organizations like the American Society of Colon and Rectal Surgeons. Once the study is complete, Cleary plans to roll it out nationally and hopes it serves as a model for other institutions.

"Although this protocol has been used strictly with the colorectal surgery population, it has applications to general surgery, as well as vascular, orthopedic and cardiac surgery," Cleary said.

St. Joseph Mercy Health System is a health care organization serving six counties in southeast Michigan including Livingston, Macomb, Oakland, St. Clair, Washtenaw and Wayne. It includes 537-bed St. Joseph Mercy Ann Arbor, 443-bed St. Joseph Mercy Oakland in Pontiac, 304-bed St. Mary Mercy Livonia, 136-bed St. Joseph Mercy Livingston in Howell, 119-bed St. Joseph Mercy Port Huron and 113-bed Chelsea Community Hospital. Combined, the six hospitals are licensed for 1,726 beds, have six outpatient health centers, four urgent care facilities, more than 25 specialty centers; employ more than 14,000 individuals and have a medical staff of nearly 2,700 physicians. It is a member of Trinity Health, the nation's fourth largest Catholic health care organization.

More at www.stjoeshealth.org.