• Q Lina Hu, Jessica Y Liu, Deborah B Hobson, Mark E Cohen, Bruce L Hall, Elizabeth C Wick, and Clifford Y Ko.
• Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. Electronic address: lhu@facs.org.
• J. Am. Coll. Surg. 2019 Dec 1; 229 (6): 626-632.e1.

BackgroundAlthough enhanced recovery pathways (ERPs) have demonstrated promising results in published literature, their effectiveness has been inconsistent. The objective of this study was to identify the most important data use practices associated with successful implementation of ERPs.Study DesignAs part of a national ERP implementation initiative, data regarding hospitals' previous ERP implementation experience were collected. Specifically, 4 data use practices (data collection, report generation, feedback to leadership, and feedback to frontline providers) and 2 data types (process measures and outcome measures) were correlated with ERP implementation outcomes (hospital-reported success and patient outcomes from the American College of Surgeons [ACS] NSQIP data).ResultsOf 140 hospitals evaluated, 73 (52.1%) reported previous ERP implementation, with wide variations in data use practices. Of these, 33 (45.2%) reported successful implementation. Feedback of both process and outcome measure data was performed by only 15.1% of hospitals, but was associated with significantly higher likelihood of successful implementation when compared with no feedback (relative risk [RR] 2.45, 95% CI 1.69 to 3.56; p < 0.001) and feedback of only outcome measure data (RR 2.73, 95% CI 1.06 to 7.00; p = 0.037). Using ACS NSQIP data from 6,888 colorectal surgery patients from 52 hospitals with colorectal ERPs, hospital-reported success was associated with significantly lower surgical site infection rates (6.6% vs 8.1%; p = 0.011) and shorter length of stay (6.2 vs 7.0 days; p < 0.001).ConclusionsThe most important data use practice associated with successful ERP implementation was data feedback to frontline providers of both process and outcome measures. However, this was rarely performed in a national cohort of hospitals and represents a substantial but straightforward opportunity for improvement.Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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