Thought Leadership

ERAS Spotlight: Q&A with Rebecca Jablonski - ERAS Clinical Nurse Leader, Spartanburg Regional Health System

March 20, 2023
By
Tracy Staniland

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway, designed to achieve early recovery for patients undergoing major surgery by minimizing the stress of surgery and supporting patients to recover quickly. 

Our ERAS Spotlight features interviews with clinical leaders who are on the front lines striving to reduce variation of care, standardize care and deliver high reliability health care.  

We spoke with Rebecca Jablonski, ERAS Clinical Nurse Leader at Spartanburg Regional Healthcare System. With more than 10,000 associates, Spartanburg Regional Healthcare System is a research and training facility with 747 beds and one of Upstate South Carolina’s largest employers. The system is comprised of six hospital campuses in Spartanburg, Union, Greer, and Gaffney. Rebecca shares her experiences and insights on deploying, scaling, and maintaining an ERAS program across multiple service lines to deliver patient-centred care, and empower care teams.

When did you launch your ERAS program and which ERAS surgical pathways have you deployed?

The ERAS Program was launched in 2017 starting with Elective Total Hip and Knee Arthroplasty and Colorectal surgery. I joined Spartanburg in September 2019 to lead the ERAS program and initiate new programs. Under my leadership, we have implemented programs for GYN/GYN ONC, Cardiac, Spine, and C-section surgeries, imbedded ERAS measures/interventions in some general surgeries and initiated an Orthopedic ERAS Pathway.

How did you secure organizational buy-in to deploy ERAS?

My predecessor did much of the heavy lifting introducing ERAS to stakeholders. With the success of our orthopedic and colorectal lines, it was not a hard sell since we were able to show reduced length of stay, readmissions, and SSIs in the first two initial service lines. When COVID-19 was causing elective surgery cancellations and bed crunches, we were strongly supported by leadership to initiate same day surgery programs for select GYN/GYN ONC, Spine, and Total Joint Replacement surgeries in July 2020, preventing a severe backlog of surgeries.

Do you have an ERAS committee? How did you establish your committee, who is part of your committee and what roles do they play in supporting the sustainment and optimization of your ERAS program?

Yes, I have separate committees for each service line. With each line, gathering baseline data like opioid consumption, LOS, readmission rates, or ambulation rates pre-ERAS implementation are important to have in order to set goals. 

To establish a committee, it is imperative to identify and incorporate the leaders and their input from each phase of care and from the various disciplines. We have a very holistic, multidisciplinary team with representation from nursing and nursing leadership in Pre-admit Testing/Pre-OP/PACU/OR/Postop units, surgeons, pharmacy, anesthesia, nutrition, rehab specialists (PT/OT), case management, Nursing Informatics, Quality, Data Analytics, Lean Engineer, and Infection Prevention.

Prior to rolling out a service line, I would suggest meeting with your surgeons/offices to present your ERAS program and share how it can help their patients' outcomes, benefits of ERAS, office staff responsibilities, reviewing proposed order set changes, etc. Upon rolling out a new service line, we would meet monthly throughout the first year and then if goals/metrics were being met consistently, we would reduce our meeting frequency to  quarterly. As a group, we also established a charter and set goals. 

Our stakeholders help to sustain each program through various roles – providing patient education throughout the surgical journey and bedside staff education, monitoring quality metrics, sub-group committees reviewing and updating order sets, education, or processes as new evidence comes out (the goal is to  review annually), and communicating metrics like post op ambulation/LOS/readmissions to bedside staff.

How do you measure the success of your ERAS program? Are there specific metrics/data that you collect, track, and analyze?

The success of our ERAS program is measured by how we have or have not met our goals that we set as a group within our Charters. We don't want to reduce LOS and have an increase in readmissions. We want to make sure LOS and readmit rates are reduced or maintained. We measure the "big ones" like length of stay, 30/90-day readmissions, SSI rates, and AKI rates. 

Other data and metrics that we track are: ambulation rates (post-op day 0-2), carb loading, pre/postop warming, SSI prevention measures, full order set use, nerve block utilization, pain scores, opioid consumption (intraop, PACU, and post-op day 0-2), and many other items. Of which, much of this is done through manual abstraction. 

Another approach that we’ve implemented to strive for success and improvement in our programs is to provide monthly data and graphs to our nurse managers to share with bedside staff. I highly recommend not only sharing "fallouts" but also sharing "wins" to encourage improvement. I regularly share positive observations from my audits when metrics and good documentation are met. Based on my observations and feedback from others, this has helped drive meeting process metrics such as ambulation or carb loading by sharing the "wins".  

The maintenance and ongoing sustainment of an ERAS program can be daunting. How have you overcome this challenge?

I am currently working with a team to create an ERAS Dashboard in Epic, our EHR, with many of the data and metrics mentioned earlier. This will greatly help (once validated) the sustainment of our ERAS programs in a more automated way. It will provide our stakeholders the ability to monitor their portions of the program and affect change quickly since these reports will be close to real-time.

What are the biggest barriers holding back the rollout of Enhanced Recovery After Surgery (ERAS) Programs, either in your own organization or in the industry?

One of the barriers I’ve encountered is a lack of time and resources to initiate new service lines since I am a "department of one". My organization embraces ERAS and would agree with me that enhanced recovery should be a standard of care for all surgeries. Sometimes encouraging our surgeon stakeholders to use the "ERAS" order sets has been a challenge in some service lines, too. To encourage surgeon order set use, I have shared with surgeons how there is a median length of stay reduction with full order set use that our Lean Engineer was able to prove with statistical significance. This sort of information speaks to our surgeons and can help drive change and adoption of the programs.

For others that are responsible for managing ERAS Programs, what resources or tools would you recommend?

I would highly recommend asking for a Quality/Data Analytics person to help build reports and dashboards directly from your EHR, liaising with your education department to help initiate and continue teaching ERAS education to all new nursing employees, and to partner with and educate your residents in your programs, as well. It is helpful to have engaged surgeon champions that are willing to go to their cohorts to support each program. Also, having engaged nursing leaders who will communicate and uphold expectations of an ERAS program with bedside staff is imperative to the success of a program.

Is there one piece of advice that you would like to share with others who are starting or scaling an ERAS Program?

The one piece of advice I would give to others is to listen to and learn all you can from others that have come before you. Those insights and lessons learned by others are invaluable resources for you. You can learn much about ERAS, protocols, supporting evidence from the various ERAS societies, etc.

Rebecca Jablonski, MSN, RN, CPAN, CNL, is the ERAS Clinical Nurse Leader for Spartanburg Regional Healthcare System. With more than twenty nine years of nursing experience, Rebecca is an active ASER Perioperative Medicine and ERAS USA Society member who is passionate about improving patient outcomes through evidence-based ERAS strategies and devoted to sharing the concept and benefits of ERAS with others. Outside of the “world of ERAS”, Rebecca enjoys kayaking, swimming, and sewing. Connect with Rebecca on LinkedIn.

ERAS Spotlight: Q&A with Rebecca Jablonski - ERAS Clinical Nurse Leader, Spartanburg Regional Health System

Posted by:
Tracy Staniland
on
March 20, 2023

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway, designed to achieve early recovery for patients undergoing major surgery by minimizing the stress of surgery and supporting patients to recover quickly. 

Our ERAS Spotlight features interviews with clinical leaders who are on the front lines striving to reduce variation of care, standardize care and deliver high reliability health care.  

We spoke with Rebecca Jablonski, ERAS Clinical Nurse Leader at Spartanburg Regional Healthcare System. With more than 10,000 associates, Spartanburg Regional Healthcare System is a research and training facility with 747 beds and one of Upstate South Carolina’s largest employers. The system is comprised of six hospital campuses in Spartanburg, Union, Greer, and Gaffney. Rebecca shares her experiences and insights on deploying, scaling, and maintaining an ERAS program across multiple service lines to deliver patient-centred care, and empower care teams.

When did you launch your ERAS program and which ERAS surgical pathways have you deployed?

The ERAS Program was launched in 2017 starting with Elective Total Hip and Knee Arthroplasty and Colorectal surgery. I joined Spartanburg in September 2019 to lead the ERAS program and initiate new programs. Under my leadership, we have implemented programs for GYN/GYN ONC, Cardiac, Spine, and C-section surgeries, imbedded ERAS measures/interventions in some general surgeries and initiated an Orthopedic ERAS Pathway.

How did you secure organizational buy-in to deploy ERAS?

My predecessor did much of the heavy lifting introducing ERAS to stakeholders. With the success of our orthopedic and colorectal lines, it was not a hard sell since we were able to show reduced length of stay, readmissions, and SSIs in the first two initial service lines. When COVID-19 was causing elective surgery cancellations and bed crunches, we were strongly supported by leadership to initiate same day surgery programs for select GYN/GYN ONC, Spine, and Total Joint Replacement surgeries in July 2020, preventing a severe backlog of surgeries.

Do you have an ERAS committee? How did you establish your committee, who is part of your committee and what roles do they play in supporting the sustainment and optimization of your ERAS program?

Yes, I have separate committees for each service line. With each line, gathering baseline data like opioid consumption, LOS, readmission rates, or ambulation rates pre-ERAS implementation are important to have in order to set goals. 

To establish a committee, it is imperative to identify and incorporate the leaders and their input from each phase of care and from the various disciplines. We have a very holistic, multidisciplinary team with representation from nursing and nursing leadership in Pre-admit Testing/Pre-OP/PACU/OR/Postop units, surgeons, pharmacy, anesthesia, nutrition, rehab specialists (PT/OT), case management, Nursing Informatics, Quality, Data Analytics, Lean Engineer, and Infection Prevention.

Prior to rolling out a service line, I would suggest meeting with your surgeons/offices to present your ERAS program and share how it can help their patients' outcomes, benefits of ERAS, office staff responsibilities, reviewing proposed order set changes, etc. Upon rolling out a new service line, we would meet monthly throughout the first year and then if goals/metrics were being met consistently, we would reduce our meeting frequency to  quarterly. As a group, we also established a charter and set goals. 

Our stakeholders help to sustain each program through various roles – providing patient education throughout the surgical journey and bedside staff education, monitoring quality metrics, sub-group committees reviewing and updating order sets, education, or processes as new evidence comes out (the goal is to  review annually), and communicating metrics like post op ambulation/LOS/readmissions to bedside staff.

How do you measure the success of your ERAS program? Are there specific metrics/data that you collect, track, and analyze?

The success of our ERAS program is measured by how we have or have not met our goals that we set as a group within our Charters. We don't want to reduce LOS and have an increase in readmissions. We want to make sure LOS and readmit rates are reduced or maintained. We measure the "big ones" like length of stay, 30/90-day readmissions, SSI rates, and AKI rates. 

Other data and metrics that we track are: ambulation rates (post-op day 0-2), carb loading, pre/postop warming, SSI prevention measures, full order set use, nerve block utilization, pain scores, opioid consumption (intraop, PACU, and post-op day 0-2), and many other items. Of which, much of this is done through manual abstraction. 

Another approach that we’ve implemented to strive for success and improvement in our programs is to provide monthly data and graphs to our nurse managers to share with bedside staff. I highly recommend not only sharing "fallouts" but also sharing "wins" to encourage improvement. I regularly share positive observations from my audits when metrics and good documentation are met. Based on my observations and feedback from others, this has helped drive meeting process metrics such as ambulation or carb loading by sharing the "wins".  

The maintenance and ongoing sustainment of an ERAS program can be daunting. How have you overcome this challenge?

I am currently working with a team to create an ERAS Dashboard in Epic, our EHR, with many of the data and metrics mentioned earlier. This will greatly help (once validated) the sustainment of our ERAS programs in a more automated way. It will provide our stakeholders the ability to monitor their portions of the program and affect change quickly since these reports will be close to real-time.

What are the biggest barriers holding back the rollout of Enhanced Recovery After Surgery (ERAS) Programs, either in your own organization or in the industry?

One of the barriers I’ve encountered is a lack of time and resources to initiate new service lines since I am a "department of one". My organization embraces ERAS and would agree with me that enhanced recovery should be a standard of care for all surgeries. Sometimes encouraging our surgeon stakeholders to use the "ERAS" order sets has been a challenge in some service lines, too. To encourage surgeon order set use, I have shared with surgeons how there is a median length of stay reduction with full order set use that our Lean Engineer was able to prove with statistical significance. This sort of information speaks to our surgeons and can help drive change and adoption of the programs.

For others that are responsible for managing ERAS Programs, what resources or tools would you recommend?

I would highly recommend asking for a Quality/Data Analytics person to help build reports and dashboards directly from your EHR, liaising with your education department to help initiate and continue teaching ERAS education to all new nursing employees, and to partner with and educate your residents in your programs, as well. It is helpful to have engaged surgeon champions that are willing to go to their cohorts to support each program. Also, having engaged nursing leaders who will communicate and uphold expectations of an ERAS program with bedside staff is imperative to the success of a program.

Is there one piece of advice that you would like to share with others who are starting or scaling an ERAS Program?

The one piece of advice I would give to others is to listen to and learn all you can from others that have come before you. Those insights and lessons learned by others are invaluable resources for you. You can learn much about ERAS, protocols, supporting evidence from the various ERAS societies, etc.

Rebecca Jablonski, MSN, RN, CPAN, CNL, is the ERAS Clinical Nurse Leader for Spartanburg Regional Healthcare System. With more than twenty nine years of nursing experience, Rebecca is an active ASER Perioperative Medicine and ERAS USA Society member who is passionate about improving patient outcomes through evidence-based ERAS strategies and devoted to sharing the concept and benefits of ERAS with others. Outside of the “world of ERAS”, Rebecca enjoys kayaking, swimming, and sewing. Connect with Rebecca on LinkedIn.

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