title: The impact of an enhanced recovery pathway on nursing workload: A retrospective cohort study.
abstract: OBJECTIVE
  The importance of nursing for surgical patients has been frequently underestimated. The success of enhanced recovery programs after surgery (ERAS) depends on preferably complete fulfillment of the protocol and nurses are an important part of it. Due to the additional nursing action required, such protocols are suspected to increase the nursing workload. The aim of the present study was to observe and measure objectively nursing workload before, during and after systematic implementation of a comprehensive enhanced recovery pathway in colorectal surgery.
  
  
  METHODS
  The program ERAS was introduced systematically in our tertiary academic centre 2011, since then our experience is based on more than 1500 ERAS patients. Nursing workload was prospectively assessed for all patients on a routine basis by means of a standardized and validated point system (PRN). In a retrospective cohort study, we compared nursing workload based on prospective data before, during and after ERAS implementation and correlated nursing workload to the compliance with the ERAS protocol.
  
  
  RESULTS
  The study cohort included 50 patients before ERAS implementation (2010) and 69 (2011) and 148 (2012) consecutive patients after implementation; the baseline characteristics of the 3 groups were similar. Mean PRN values were 61.2 ± 19.7 per day in 2010 and decreased to 52.3 ± 13.7 (P = 0.005) and 51.6 ± 18.6 (P < 0.002) in 2011 and 2012, respectively. Increasing compliance with the ERAS protocol was significantly correlated to decreasing nursing workload (ρ = -0.42; P < 0.001).
  
  
  CONCLUSIONS
  Nursing workload is--against a common belief--decreased by systematic implementation of enhance recovery protocol. The higher the compliance with the pathway, the lower the burden for the nurses!
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Switzerland. Electronic address: martin.hubner@chuv.ch.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Switzerland. Electronic address: valerie.addor@chuv.ch.
authors.forename: Valerie
authors.initials: V
authors.lastname: Addor
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Switzerland. Electronic address: juliette.slieker@chuv.ch.
authors.forename: Juliette
authors.initials: J
authors.lastname: Slieker
authors.affiliation: Medical Direction, University Hospital of Lausanne (CHUV), Switzerland. Electronic address: anne-claude.griesser@chuv.ch.
authors.forename: Anne-Claude
authors.initials: AC
authors.lastname: Griesser
authors.affiliation: Medical Direction, University Hospital of Lausanne (CHUV), Switzerland. Electronic address: estelle.lecureux@chuv.ch.
authors.forename: Estelle
authors.initials: E
authors.lastname: Lécureux
authors.affiliation: Department of Anaesthesiology, University Hospital of Lausanne (CHUV), Switzerland. Electronic address: catherine.blanc@chuv.ch.
authors.forename: Catherine
authors.initials: C
authors.lastname: Blanc
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Switzerland. Electronic address: demartines@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000451:nursing*; D019091:Critical Pathways; D013505:Digestive System Surgical Procedures / Q000451:nursing* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses'; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D016526:Workload / Q000523:psychology*; D055815:Young Adult
keywords: Colorectal; Compliance; Enhanced recovery; Fast track; Nursing workload