Patrick Sullivan Mentee Receives ASCRS Grant

July 2016

Giacomo Waller, an Emory 4th year medical student working with Emory's Enhanced Recovery After Surgery (ERAS) Colorectal Group led by Patrick Sullivan, MD, has been awarded an American Society of Colon and Rectal Surgeons (ASCRS) grant to study whether the use of the Fitbit, a wireless activity tracking device, will increase ambulation after colorectal surgery.

"The hypothesis is that a device with alarm reminders will motivate patients to walk more than a device without them," says Waller. "Increased ambulation is thought to result in decreasing such postoperative complications as ileus, venous thrombosis, and pulmonary issues."

ERAS programs incorporate evidence-based best practices that have been shown to decrease length of stay and perioperative complications for patients who undergo colon and rectal procedures. Sullivan, assistant professor of surgery and chief quality officer of the Division of Surgical Oncology, is the medical director of the Emory-based ERAS group. With the administrative support of neurologist Gregory Esper, MD, director of new care models for Emory Healthcare, Sullivan works closely with Emory colorectal surgeons Virginia Shaffer, MD, Jahnavi Srinivasan, MD, Charles Staley, MD, and Seth Rosen, MD, to optimize patient value through implementing best practice.

In Waller's clinical trial, enrolled patients will be encouraged to exercise daily prior to their elective colorectal surgery. Following surgery, the patients will be provided with wrist Fitbits and randomized to either receive five daily reminder sound/vibration alarms to ambulate versus no alarms for nine days or until discharge. Step count and patient demographic data will be added to a database that allows comparison of the two groups' average daily step counts and other metrics. Quantitative data between the groups will be analyzed to determine if frequent daily reminders are successful to increase ambulation. Secondary outcomes of the study include the frequency of respiratory complications, blood clots, bowel recovery, and length of stay between the groups.

"Early ambulation seems like a simple intervention, but it has been a struggle for our team to implement and measure effectively. This study will determine whether or not ambulation tracking devices can change behavior," Sullivan says. "Activity trackers have been successful in outpatient settings. They appear highly motivational, and can provide automatic synching and data export capability. Giacomo's ingenious study could offer a simple and very cost effective solution to this issue.”

Dr. Staley, Holland M. Ware Professor of Surgery and chief of the Division of Surgical Oncology, has been a strong source of encouragement for the colorectal team's dedication to quality and value. "Dr. Staley was aware of the funding opportunity, encouraged us to apply for the grant, and offered advice about the trial design. His leadership has energized our efforts," says Sullivan.

Waller will be doing much of the footwork for the trial, including patient screening, obtaining patient consent, monitoring and maintaining data collection, and analyzing the data. "I hope this project will be the first step in establishing a solid foundation for my goals of becoming a surgeon and clinical investigator equipped with the skills to design, execute, and publish studies to investigate patient care and demonstrate avenues of improvement," he says.

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