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Outcomes Following Implementation Of Team Integrated Enhanced Recovery (tiger) Protocols - The University Of Missouri Experience
*Milot Thaqi, *Raul Castillo, *Kathleen Quinn, *Jane McElroy, *Mirna Becevic, *Kevin Staveley-O'Carroll, Eric Kimchi
University of Missouri, COLUMBIA, MO

Introduction: Enhanced recovery protocols have made great strides to improve patient outcomes following surgery since the early 1990's, through a multimodal, multi-disciplinary approach to the care of surgical patients. Since its inception at The University of Missouri Hospital, these protocols have resulted in a 30-50% decreased length of total hospital stay, including a decrease in the number of ICU days, and post-operative pain.
Methods: The TIGER (Team InteGrated Enhanced Recovery) Protocol was drafted after a comprehensive literature review and was formulated as an institutional specific enhanced recovery protocol utilizing data from MD Anderson Cancer Center and the data from Ellis Fischel Cancer Center. While the implementation of the protocol involves peri-operative and intra-operative elements, we examined the intra-operative component of the protocol on surgical oncology patients as a quality improvement measure. Specifically, we wanted to determine whether total length of hospital stay, pain control and the number of ICU days improved after implementation of the protocol. We examined 100 cases utilizing the protocol, and retrospectively reviewed 100 similar case during the two years immediately preceding the implementation of the protocol.
Results: The data was analyzed using t-test and chi-square tests with a P value <0.05 considered significant. Based on the results, the implementation of the intra-operative protocol reduced the average length of hospital stay from 8.8 days to 6.0 days, a decrease of 32%. We also found that the average pain ratings, in the first post-operative day, was consistently lower in the protocol group. Finally, the number of total ICU admissions decreased from 55 to 32, demonstrating a reduction of 42%, and a total reduction of 60 ICU admission days within the first 3 post-operative days.
Conclusion: Following the implementation the TIGER protocol, our institution was able to demonstrate reduction in the length of stay, improvement in pain control and ICU admission. With continued expansion of the perioperative enhanced recovery protocol, we should see continued improvement in patient outcomes.


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