After undergoing major surgeries like a hip replacement or hysterectomy, it was common for patients to be put on bed rest for an extended period of time. Pain was managed primarily with narcotics and individuals were gradually reintroduced to eating food.
However, research has shown these traditional practices lead to further complications and lengthen the time spent in the hospital. It can also result in extended recovery time for individuals. Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the American College of Surgeons (ACS) introduced the Enhanced Recovery After Surgery (ERAS) project.
The ERAS program is a set of evidence-based protocols health care systems are encouraged to use that are shown to reduce costs, improve safety and shorten recovery times for surgical patients. OSF HealthCare Saint Francis Medical Center, with help from Performance Improvement (PI), began implementing these procedures for certain surgeries to great success. They are now being used for four types of surgeries and will be spread to even more.
The ERAS program aims to impact the entire patient journey, beginning with the time an individual is scheduled for surgery. That means engaging patients with counseling about the enhanced recovery pathway and ensuring they are healthy before their operation. It means using non-opioid pain medications during and after surgery. After the operation, it means mobilizing patients earlier.
“Making this effort successful has required buy-in from preoperative staff, clinical educators on the hospital floors, anesthesia, surgeons and the post-op team,” said Andrew Crusen, PI specialist for OSF Saint Francis. “More importantly, it has required patients to be active participants in their own recovery.”
So far, ERAS protocols have been implemented for total joint replacement, colorectal surgery, total shoulder replacement and gynecological surgery. They are under development for lumbar fusions, as well as bariatric and hip fracture surgeries.
“As we have rolled out these practices within OSF Saint Francis, we’ve had many surgeons asking for help to implement them within their service lines,” said Jodee Driscoll, a PI specialist for OSF Saint Francis. “It’s exciting to have interested and engaged providers, offices and surgeons embrace this concept and bring it to their patients.”
The ERAS program was particularly useful when COVID-19 hit last year. In some cases, patients were able to leave the hospital the same day they received their surgeries.
How is it working?
Nationwide, ERAS practices have been shown to reduce the amount of time patients spend in the hospital and decrease the chance of re-hospitalization. It lowers the use of opiate pain therapy, improves patient outcomes and reduces the cost of care.
“Deployment of ERAS protocols has had an incredible impact,” said Elli Berardi, the Pre- and Post-Surgery and Cath Lab manager for OSF Saint Francis. “The biggest win for us has been an improvement in patient experience. We are seeing individuals leaving our facility the next day after surgery as opposed to the three and four days it took before we began this program.”
This is just one way Performance Improvement, a part of OSF Innovation, utilizes rigor and partners with Mission Partners and subject matter experts to improve care for our patients.