Annually, more than 234 million major operations are performed worldwide. Of these operations, an estimated 20% of patients will suffer post-surgical complications that are known to increase hospital length of stay (HLOS), cost of care and the likelihood of adverse outcomes.
Several evidence-based perioperative care elements exist that hold the potential to reduce post-surgical complications and cost of care while getting patients recovered and home faster. Collectively, these elements form the basis of published enhanced recovery after surgery (ERAS) guidelines now implemented in 20 countries across the globe.
“Why Should My Facility Consider ERAS?”
The short answer: Improved surgical outcomes.
ERAS outcome effectiveness is usually demonstrated by improved patient satisfaction with decreases in post-surgical complications, HLOS and cost of care. HLOS is closely associated with the return of bowel function, which is affected by fluid status, gut ischemia, narcotic administration, pain and the presence or lack of early postoperative ambulation and alimentation.
The key elements of ERAS protocol go beyond throughput metrics, opioid use reduction and perioperative fluid management.
“Must ERAS Protocol Adhere to This Established List?”
No. While it’s generally believed that adherence to all guidelines yields the best outcomes, enhanced recovery pathways with as few as two elements have shown value and clinical benefit.
In fact, when Envision’s anesthesiology group implements ERAS protocol with one of our partner facilities, we start with seven core components.
Learn more about those seven components here.
“How do I Implement ERAS Protocol?”
Because ERAS guidelines are so dynamic and multifaceted, the introduction of this protocol should be staged in tiers so as not to overwhelm any one group of clinicians or their support teams. With each of the seven core components, clinicians and healthcare leaders will face unique obstacles, but they each share one particular hurdle: building consensus and securing buy-in across leadership and clinical teams.
Securing Buy-In Takes Reinforcement and Perseverance
With every step of implementation, one may encounter doubt, reticence and even apathy regarding the potential benefits of changing perioperative and postoperative protocols. The key to overcoming these hurdles is to continuously demonstrate value to patients, clinicians and hospitals.
When Envision began implementing ERAS protocol nearly a decade ago, we partnered with colorectal surgeons to develop custom protocols because they have ample experience with multimodal pain.
From discussions with these surgeons, the team gleaned just how effective multimodal pain packages could be at reducing complications and expediting discharge, aiding in the development of new guidelines for the anesthesia and surgical teams. The team condensed this knowledge into toolkit booklets that could be disseminated among Envision partner facilities. Envision also enlisted the help of international experts to coach and essentially pitch frontline clinicians on the value of these changes.
However, the best way to demonstrate the value of ERAS protocol is through continuous data collection and follow-up with clinicians, support teams and hospital leaders.
Learn more about these datasets and how you can leverage them to streamline the implementation of ERAS protocol here.
Delivery of high-quality healthcare relies not only on clinical evidence and expertise, but also on the establishment of clear benefits to every party involved: patients, clinicians, hospital leaders and ancillary support staff.
By implementing ERAS protocol even on a smaller scale, we create better perioperative and postoperative conditions for patients and clinicians alike, ultimately improving care quality and patient experience while reducing bed utilization. Prioritizing this protocol will raise the bar on the level of care we can offer our communities, making healthcare work better for everyone.
Emily Olsen 
Ricky Zipp 
Susanna Vogel