Enhanced Recovery After Surgery Case Study

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Introduction In the last five years, Enhanced Recovery After Surgery (ERAS) pathways for colorectal resection have been thrust into spotlight with evidence of expedited recovery time and improved postoperative outcomes1–5. However, there exists little uniformity in the recommendations and results of published ERAS pathways, and there is some evidence suggesting that the wrong cocktail of bundle elements can increase Surgical Site Infection (SSI) rates6. This inconsistency can be attributed to a lack of consensus on the efficacy of some common bundle elements, such as preoperative antibacterial showering, maintenance of normothermia, and high intraoperative Fraction of Inspired Oxygen (Fi02) 7–15. Such dissonance in studied ERAS efforts…show more content…
Creating a program that uniformly reduces these complications is a significant advancement in quality of care, an improvement to patient health and satisfaction that is rewarded by government payment programs. With this in mind, CSC set out to develop and implement an ERAS pathway consistent enough to allow sustainable compliance regulation but flexible enough to suit a network with academic medical centers and community hospitals. Our goal was to design evidence based practice, reduce length of hospital stay, prevent post-op complications and readmissions, decrease SSI rate and improve financial burden associated with CMS payment programs including Value based purchasing and HAC reduction program. This pathway addressed hurdles of its forbears with a five-pronged approach. First, a systematic review of the literature was conducted to define the essential elements of a successful ERAS pathway and to understand the logistical hurdles faced by past implementation efforts. Second, a “grassroots” pathway was developed through consensus among stakeholders across Partners hospitals. Third, compliance was encouraged through a decision support scheme built directly into the EHR that was updated to reflect ERAS care decisions across providers. Fourth, the Partners Internal Performance Framework (IFP) was leveraged to encourage each site to develop its own sustainable workflow and regulatory body. Fifth, concise and diverse patient education materials were

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