CASTOMized project: a new comprehensive collaborative approach between case manager and stoma care nurse.

Background: The use of the Enhanced Recovery After Surgery (ERAS) care pathway is becoming more widespread in surgical specialties. However, the presence of an ostomy, and the patient's need to adapt quickly to living with a stoma, is described as the Achilles' heel of the ERAS pathways in colorectal surgery.

Aim: To investigate the efficacy of applying a new patient pathway within the ERAS protocol.

Design: A retrospective observational study.

Method: The management of patients undergoing surgery for colorectal disease and stoma formation between January 2023 and December 2023 was reviewed. Two clinical nurse specialists collaborated to integrate interventions and pathways.

Findings: Of the 99 colorectal cancer or inflammatory bowel disease patients included in the study, the stoma care and management for 96 (95.9%) of the group fully adhered to the pathway. A median hospital stay of 11 days was recorded, with an interquartile range of 9 days; 40% of patients were treated as emergency cases. Adherence to the ERAS protocol (nursing care items) was 98%. Most patients were discharged home (91%). Adherence to telephone follow-up decreased over time, but remained above 90%. In the immediate post-discharge period, the percentage of patients with a high-output stoma was established at 15%, with only 3 (3%) of these requiring re-admission.

Conclusion: The study highlights the benefits gained by entrusting advanced practice nurses with the integrated management of care pathways in ostomy patients.