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WHY CONTINUOUS AUDITING IN PERIOPERATIVE CARE?

Continuous Auditing of Surgical Processes: Enhancing Patient Outcomes and Operational Efficiency.

“It is not enough to do your best; you must know what to do, and then do your best.” /W. Edwards Deming

In the rapidly evolving healthcare landscape, continuous auditing of surgical processes is crucial for improving patient outcomes and operational efficiency. Extensive research supports this practice, demonstrating the significant impact of systematic monitoring and evaluation in surgical care.

Why Continuous Auditing in Perioperative Care

Improved Patient Outcomes
Of the 313 million major surgeries performed globally every year, as many as 50 million patients experience complications after surgery. Studies indicate that up to half of these complications are preventable if best practices are followed. Continuous auditing allows for real-time monitoring of surgical processes, enabling immediate identification and rectification of deviations from best practices. Proactive auditing significantly reduces postoperative complications and enhances overall patient recovery rates.
Data-Driven Decision Making
Regular audits generate a wealth of data that can be analyzed to identify trends, areas for improvement, and the effectiveness of implemented changes. This data-driven approach ensures clinical decisions are based on empirical evidence, leading to more effective and efficient patient care strategies.
Standardization of Care
Auditing helps standardize surgical procedures by ensuring adherence to established protocols and guidelines. This uniformity in practice reduces variability in patient outcomes and fosters a culture of excellence and reliability within surgical teams.
Cost Efficiency
By identifying inefficiencies and areas of waste, continuous auditing contributes to significant cost savings. Improved surgical outcomes and reduced complication rates lead to shorter hospital stays and lower overall healthcare costs. Furthermore, better quality care often results in lower costs, as highlighted in value-based healthcare models, which emphasize that higher quality care leads to fewer complications, readmissions, and resource utilization.
Enhanced Accountability and Compliance
Regular audits ensure surgical teams remain accountable for their practices, fostering a culture of continuous quality improvement and compliance with regulatory standards. This accountability is crucial for maintaining high standards of patient safety and adherence to national and regional quality standards and requirements.
Comprehensive Compliance with ERAS® Guidelines
The Enhanced Recovery After Surgery (ERAS)® Guidelines encompass a comprehensive set of compliance items, including preoperative, intraoperative, and postoperative care protocols. Continuous auditing ensures adherence to these guidelines, designed to optimize patient outcomes and recovery. Monitoring compliance with each element of ERAS® protocols helps identify gaps in practice and areas for improvement, leading to more consistent and high-quality care.

HOW TO AUDIT?

Implementing Continuous Auditing in Surgical Processes.

Establish Clear Objectives
Define specific goals for the auditing process, such as reducing infection rates, improving adherence to surgical techniques, or enhancing patient satisfaction. Start by establishing a pre-ERAS® baseline to define and set these objectives effectively.
Implement Standardized Comprehensive Audit Tool
Utilize a proven standard tool like the international ERAS® Interactive Audit System (EIAS) instead of developing local tools, which may lack consistency and comprehensiveness. EIAS ensures robust data collection, allowing for effective monitoring, continuous improvement, and participation in multi-center and multi-country clinical trials and research.
Train and Empower StaffTrain and Empower Staff
Ensure all members of the surgical team are adequately trained in the auditing process and understand its importance. Training should also include the latest best practices, such as ERAS® guideline knowledge and understanding. Empower staff to actively participate in audits and contribute to continuous improvement efforts.
Utilize Technology
Leverage technology to streamline the auditing process, such as electronic health records (EHR) systems and data analytics platforms. Dedicated ERAS auditing tools like EIAS are crucial, as locally developed tools often lack the consistency and comprehensiveness necessary for effective auditing and do not enable international benchmarking and research.
Foster a Culture of Continuous Improvement
Encourage a culture where continuous improvement is valued and rewarded. Regularly review audit findings with the surgical team and collaboratively develop action plans to address identified issues.
The Importance of Auditing Both Processes and Outcomes
Measuring outcomes is essential, but it’s only part of the equation. Without auditing the processes that lead to these outcomes, healthcare providers are left reacting to issues rather than preventing them. Auditing processes allow for early detection and correction of problems before they impact patient results. This dual focus on both process and outcome data is critical for making fully informed, data-driven decisions.
With actionable data from both processes and outcomes, providers can pinpoint specific areas of improvement within the surgical workflow, leading to more effective and timely interventions. This comprehensive approach enables providers to achieve better patient outcomes, improve patient safety and sustain these improvements over time, ultimately driving consistently higher standards of care and greater operational efficiency.

THE SHOW MUST GO ON!

The Rationale for Continuous Auditing

Continuous auditing should be an ongoing process rather than a time-limited project. Research has shown that ongoing audits lead to sustained improvements in patient outcomes, lower complication rates, and better adherence to protocols. Stopping the auditing process can result in regression to previous less effective practices and the loss of gains achieved through continuous improvement efforts. Therefore, maintaining a continuous auditing process is essential for long-term success and consistent quality of care.

CONCLUSIONS

Continuous auditing of surgical processes is a cornerstone of modern surgical care, providing numerous benefits to both patients and healthcare institutions.
By embracing this practice, healthcare institutions can ensure the highest standards of patient care, operational efficiency, and compliance with quality standards. The commitment to continuous improvement ultimately leads to better patient outcomes, reduced healthcare costs, and a more resilient and effective healthcare system.

For more information on implementing continuous auditing in your institution, please contact us at Encare.

“You can’t manage what you don’t measure” /Peter Drucker

DIY ERAS vs ERAS® by Encare

Guideline
Interpretation
Compliance
Actionable Data
Updates and Improvements
Proven
International
Community
ERAS® Qualification / Center of Excellence (CoE)
Availability
Technical and
Clinical Support
Research

Dependent on the at all times locally available clinical knowledge and will not be 100 % in line with guideline author’s interpretation
At best partially compliant
At best partially - normally either only process data or outcome data
Ad hoc updates dependent on local resource constraints Not at the same time as the other ERAS hospitals
Reinvent the wheel
Not available
Not available
When the hospital has had the time and resources to develop the necessary tools
Requires internal support to be set up
Probably single center trials – national coverage at best

Encare develop the EIAS protocol with the ERAS® guideline author and ensure a 100 % interpretation including access to ERAS® Society trainers, coaches and authors
The only way to consistently monitor the official ERAS® compliance
Both comprehensive Process and Outcome data enabling to pinpoint specific areas of improvement
EIAS is a SaaS solution and when the ERAS® guideline is updated, the EIAS protocol is updated for all hospitals at the same time. The SaaS solution is continuously improved based on different input from all Encare customers
The solution has been battle tested at > 300 teams in + 30 countries for +15 years
Possible to benchmark your results with many of the most prominent hospitals in the world and take part in multi-center research projects as all gather data in an uniform way
If the team meets the ERAS® Society standards, the team will be awarded an ERAS® Qualification and can possibly become an ERAS® Center of Excellence
Instantaneously available once the contract is signed
Access to ERAS® clinical expertise or Encare solution support in the same support channel
Multi-center and multi-country trials enabling RRCTs

REFERENCES

Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. *Ann Surg*. 2008;248(2):189-198.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. *JAMA Surg*. 2017;152(3):292-298.
Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. *World J Surg*. 2013;37(2):259-284.
Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. *Surgery*. 2011;149(6):830-840.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. *World J Surg*. 2014;38(6):1531-1541.
Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? *Can Urol Assoc J*. 2011;5(5):342-348.
Lee L, Li C, Landry T, Latimer E, Carli F, Fried GM. A systematic review of economic evaluations of enhanced recovery pathways for colorectal surgery. *Ann Surg*. 2014;259(4):670-676.
Thiele RH, Rea KM, Turrentine FE, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. *J Am Coll Surg*. 2015;220(4):430-443.
Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. *Clin Nutr*. 2010;29(4):434-440.
Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. *Arch Surg*. 2011;146(5):

WHY CONTINUOUS AUDITING IN PERIOPERATIVE CARE?

“It is not enough to do your best; you must know what to do, and then do your best.” /W. Edwards Deming

The ERAS® Interactive
Audit System (EIAS)

Why Continuous Auditing in Perioperative Care

HOW TO AUDIT?