Optimizing Outcomes with Enhanced Recovery

Julie Thacker, Nancy Morin
Optimizing Outcomes with Enhanced Recovery is a topic covered in the ASCRS Textbook of Colon and Rectal Surgery.

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Key Concepts

  • Enhanced recovery is the process of defining modifiable sources of perioperative stress to the surgical patient and applying standardized evidence-based interventions through all phases of care to avoid complications, facilitate faster recovery and discharge (without increasing readmission rates), and reduce hospital costs.
  • Champions from surgery, anesthesia, and nursing are essential to the ERAS team, while other members for protocol creation include pharmacy, IT, nutrition, and administration.
  • Key elements of patient care delivery can be broken down into five phases, each assigned to and delivered by a different team while certain elements present across phases: preoperative, perioperative, intraoperative, postoperative, and post-discharge.
  • Implementation of the Enhanced Recovery Program, ERP, requires order sets, team education, and administrative help as well as databases to facilitate data collection and ensure optimal compliance and quality control.
  • ERAS principles are widely applicable and have been proven safe and beneficial in emergency and IBD patients, those with diverting ostomies, and elderly patients, realizing that readiness for discharge rather than length of stay is a more accurate outcome measure.
  • Moving forward, technology will assist in gathering patient recovery-centric outcome measures in addition to the traditional audit measures to further quality improvement efforts.

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Key Concepts

  • Enhanced recovery is the process of defining modifiable sources of perioperative stress to the surgical patient and applying standardized evidence-based interventions through all phases of care to avoid complications, facilitate faster recovery and discharge (without increasing readmission rates), and reduce hospital costs.
  • Champions from surgery, anesthesia, and nursing are essential to the ERAS team, while other members for protocol creation include pharmacy, IT, nutrition, and administration.
  • Key elements of patient care delivery can be broken down into five phases, each assigned to and delivered by a different team while certain elements present across phases: preoperative, perioperative, intraoperative, postoperative, and post-discharge.
  • Implementation of the Enhanced Recovery Program, ERP, requires order sets, team education, and administrative help as well as databases to facilitate data collection and ensure optimal compliance and quality control.
  • ERAS principles are widely applicable and have been proven safe and beneficial in emergency and IBD patients, those with diverting ostomies, and elderly patients, realizing that readiness for discharge rather than length of stay is a more accurate outcome measure.
  • Moving forward, technology will assist in gathering patient recovery-centric outcome measures in addition to the traditional audit measures to further quality improvement efforts.

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Last updated: January 26, 2022