Enhanced Recovery Pathway, Endoscopy
Conditions
Brief summary
The purpose of this study is to compare an Enhanced Recovery Pathway to the current pre-operative/recovery practices of the endoscopy department on patient post-procedure outcomes.
Detailed description
Every 4th to 5th patient that checks in to the endoscopy department for their procedure will be screened for eligibility requirements. If eligible for the study, the patient will be informed about the study and potential risks. All patients giving written informed consent will be enrolled into the enhanced recovery protocol (ERP) \[nursing managed ERP: goal-directed fluid management (Lactated Ringer's Solution at 5mL/kg/hr), PONV prophylaxis for an apfel score of 2 or greater (ondansetron 4 mg IV), early mobilization up to chair (within 5-30 minutes of admission to the recovery room), and early PO intake within 15-30 minutes of admission to the recovery room post-procedure\] for their procedure.
Interventions
OTHEREarly PO Intake
Patient will be offered PO intake within 15-30 minutes of admission to the recovery room post-procedure based on nursing parameters and patient safety.
DRUGOndansetron 4 MG
PONV prophylaxis for participants with an apfel score of 2 or greater (ondansetron 4 mg IV), an additional dose of ondansetron 4mg IV will be available in recovery if the patient has nausea/vomiting despite prophylaxis.
Goal directed IV fluids to be administered starting preop per the NMH Colorectal ERAS protocol (LR @ 5mL/kg/hr).
OTHEREarly Mobilization
Patient transferred up to the chair (within 5-30 minutes of admission to the recovery room) based on nursing parameters and patient safety.
Sponsors
Northwestern University
Study design
Allocation
NON_RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Outpatient colonoscopy under moderate sedation * Colonoscopy Indications: Screening
Exclusion criteria
* More than one sedation procedure scheduled same day * Allergy to ondansetron * Past PONV requiring scopolamine patches * Diagnoses: ESRD, heart failure, cirrhosis, long QT syndrome * Patients requiring fluid restrictions, such as dialysis patients * Post-procedure NPO requirements, such as procedure-related NPO status (stent placement, pneumatic dilation, etc.) or second procedure in another location * High Fall Risk Patients * Adults unable to consent * Pregnant patients
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To compare recovery time stamps before and after implementing a modified ERAs for endoscopy patients in the recovery period. | 1-2 hours | We will compare mean recovery times between control and intervention groups using analysis of variance (ANOVA). |
| To compare the incidence of postoperative nausea and vomiting before and after implementing a modified ERAs for endoscopy patients in the recovery period. | 1-2 hours | We will perform a Chi-square analysis for presence or absence of nausea and/or vomiting in the recovery period (measured by: administration of anti-emetic, documentation on N/V flowchart, and/or documentation in nursing narrative note) between control and intervention groups. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To compare patient satisfaction scores before and after implementing a modified ERAs for endoscopy patients in the recovery period. | 15 minutes | We will perform a t-test of patient satisfaction scores (Press Ganey scores) between control and intervention groups. |
Countries
United States
Outcome results
None listed