Abstract
Objectives: ERAS Pathways although straight forward to map out on paper are extremely difficult to implement in practice because of the structure of modern health care systems. Siloing of finances, lack of senior executive and physician buy in, together with hospital wide education can all impede implementation. The other major issue is hard wiring the pathway into a Powerplan in the Electronic Medical Record and collecting data to audit compliance. We proposed an implementation program across the Health System that would break down all surgical pathways into the following vertical section: Preoptimization, Presurgical Unit, Operating Room, PACU and ward. We then mapped the horizontal process for each Surgical Specialty with emphasis on fluids, analgesia and surgery specific issues.
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