Pathways to Enhanced Recovery
In 2009 the ORI performed research that ultimately transformed how care is delivered to head and neck surgical patients. This early research showed that head and neck surgery patients were not moving soon enough, were getting too many complications and were staying in the hospital too long. This information led to the development of clinical pathways to streamline and coordinate care for patients undergoing major head and neck surgery with free flap reconstruction.
Creating enhanced recovery pathways (ERPs) was a major challenge. However, teamwork and commitment to improve patient care prevailed and the Calgary head and neck ERP was put into production in the fall of 2010. Since that time over 400 patients have been managed using the Calgary ERP and the results have transformed care of head and neck surgery patients in Calgary and elsewhere.
The Calgary ERP has:
- Reduced lung complications from 30% to less than 4%
- Allowed patients to start moving on the day of surgery instead of waiting 4 days
- Reduced time in the intensive care unit from over 3 days to less than 1 day
- Enabled patients to go home in 10 days instead of over 3 weeks
- Reduced the costs of hospital care for major head and neck surgery by almost 40%
And – perhaps most important of all – the Calgary ERP has enabled a change in culture that enhanced learning of team members, facilitated data-driven clinical decision making, reduced variation in care so that treatments are more consistent and reliable and established a system of measurement, audit and feedback to inform ongoing improvements.
Our results have been published and shared with colleagues in Canada and around the world and the Calgary ERP is seen as a model of care to be emulated in other head and neck programs.