Implementation of an enhanced recovery after surgery program

Abstract

Enhanced recovery after surgery (ERAS) is an iterative, multidisciplinary approach used to achieve improved surgical outcomes, such as decreasing length of hospitalization, complications, readmission rates, and overall cost, while improving patient care quality. These results are achieved when current evidence-based best practices are used to decrease practice variability and improve multidisciplinary team coordination. The idea for ERAS, or a “fasttrack” recovery program, was initially described in the 1990s, and the first widely used application of ERAS was in recovery from coronary artery bypass surgery.1 Over the last 20 plus years, the ERAS concept has expanded to many different services and surgeries. At the authors’ institution, the median total length of stay (LOS) for patients undergoing colorectal surgery was 6.4 days with a readmission rate of 21%. Evidencebased best practices were not being used with this patient population. A review of the literature indicated that this was an opportunity for improvement. There is a great deal of literature regarding ERAS in the colorectal surgery population, which guided the start of this new program. The literature indicated potential LOS reductions of 30% to 50% with similar reductions in complications, while reducing readmissions and cost.2 For these reasons, the authors piloted this ERAS program in the colorectal surgery division of general surgery and have since expanded it to gynecology-oncology, benign gynecology, urology, and spinal surgery (adults and pediatrics). This article reviews the implementation of a quality initiative and development of an ERAS program, called the ERAS pathway, as well as some of the challenges and successes the ERAS pathway has experienced, specifically from a nursing perspective.