First year experience of a U.S. community hospital with a European modeled ERAS programme

Abstract

Objectives: The objective was initiation of an ERAS programme in general surgery patients modeled on published European experiences. The project team sought to reach full penetration into all general surgery practices within one year. Methods: A dedicated project team consisting of two anaesthesiologists, one CRNA, and one ARNP collected evidence-based data on all elements of the ERAS pathway. The specifics of the pathway, including preoperative and postoperative order sets, were designed and placed into an EMR for ease of use by all practitioners. Education meetings were arranged for the anaesthesiologists, surgeons and nurses. The overall programme was presented to management to solicit resource support. An early adopter surgeon was selected to trial the pathway. The initial patient experience was used to recruit other surgeons and anaesthesiologists to the programme. Results: Variable direct costs per case for open colon and small bowel surgery declined significantly, from $10,788 to $6,431. Length of stay was reduced on average by 50%, from 11.4 days to 5.1 days. All surgeons adopted the ERAS programme and reduced their length of stay significantly. Conclusion: Assembling a dedicated team that uses evidence based data to design and oversee an ERAS programme is a successful approach to incorporating this patient care path into a community hospital. Our impression is that adoption of new patterns of practice by physicians requires evidence and a smooth transition to new schemes. The final elements are an early adopter among the surgeons and the anesthesiologists to initiate the programme. Positive results enhance the solicitation of late adopters to use ERAS. Disclosure of Interest: P. Shanahan Speaker Bureau of: Edwards Life Sciences