The Impact of the Nurse Navigator on Patients on a Colorectal Surgery Pathway

Bordonada, Kelsie
Davo-Otomo, Sharon
Zucker, Maria Elena
Saito, Hang

Kelsie Bordonada, BSN, RN-BC, PCCN, is Clinical IV Staff Nurse, Medical Surgical Telemetry Unit, Queen's Medical Center, Honolulu, HI.
Sharon Davo-Otomo, BSN, RN-BC, is Clinical IV Staff, Queen's Medical Center, Honolulu, HI.
Maria Elena Zucker, MSN, APRN-Rx, FNP-BC, is Perianesthesia Nurse Practitioner, Pre-Surgery Center, Queen's Medical Center, Honolulu, HI.
Hang Saito, MSN, APRN-Rx, FNP-BC, is Perianesthesia Nurse Practitioner, Pre-Surgery Center, Queen's Medical Center West Oahu, HI.
Acknowledgments/Disclaimer/Funding: The authors acknowledge The Queen's Medical Center and Queen Emma Nursing Institute for their support of this study and manuscript development.

The findings and conclusions of this study do not necessarily represent the views of The Queen's Medical Center.

The authors acknowledge Rui Fang, MS, for support with statistical analysis. Ms. Fang was partially supported by grants U54MD007584 and U54MD007601 from the National Institute on Minority Health and Health Disparities (NIMHD) and P20GM103466 from the National Institute of General Medical Sciences (NIGMS) from the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

MEDSURG Nursing 29(2):p 116, March-April 2020.

Nurse navigators have emerged recently to address the changing healthcare system and further focus on patient needs. This study found education of patients by nurse navigators can help manage patients' expectations and contribute to improved adherence to the Enhanced Recovery After Surgery pathway.

Background

Enhanced Recovery After Surgery (ERAS) is a perioperative evidence-based fast-track, multimodal program shown to decrease surgical site infection (SSI) and hospital length of stay (LOS). However, organizations face difficulty with patient protocol adherence. Studies show the addition of a nurse navigator to coordinate care results in reduced Emergency Department visits and readmissions.

Aim

Determine if patient adherence to the ERAS pathway increased with the dedication of a nurse navigator and influenced LOS, SSI rates, and hospital readmission rates for patients undergoing elective colorectal surgery.

Method

A retrospective chart review compared 100 patients on the ERAS pathway from two facilities within the health system (admissions September 2015-April 2018). The study was divided into Phase I (without navigator) and Phase II (with navigator).

Results

Statistical differences presented in 6 of 22 data points for Phase II, including patients who received ERAS protocol education, were referred to Pre-Surgery Center, consumed Gatorade, had head of bed elevated 30 degrees, and had measures to prevent postoperative nausea and vomiting. Fewer patients were discharged with analgesia. No statistical differences were found in LOS, readmission rates, and occurrence of SSI.

Limitations and Implications

A small convenience sample was used. ERAS was a new protocol for the facilities and had a small number of participating surgeons.

Conclusion

Use of nurse navigators may impact patient adherence to protocols, improve patient outcomes, and may decrease the need for analgesia at discharge, thus promoting high-quality, cost-effective health care.