Implementation of Enhanced Recovery After Surgery in a Community Hospital: An Evidence-Based Approach

Abstract

Enhanced recovery after surgery (ERAS) is an evidence-based practice protocol that has been shown to reduce cost, decrease length of stay (LOS), and improve surgical outcomes. An evidence-based practice improvement project with a multidisciplinary team translated the ERAS protocol into practice at a community hospital. The evidence-based practice improvement design allows integration of evidence into projects to improve clinical outcomes for patients. Small tests of change using the Plan-Act-Study-Do methodology were used to evaluate the process of implementing one surgical service at a time to ensure effective outcomes. After the process was determined to be effective, patient outcomes (eg, LOS) were measured. On average, LOS was decreased from 3.2 to 1.7days. Surgical readmission rate decreased from 3% to 1%. There has been positive feedback and nursing workload has decreased with consistent processes. The ERAS order set continues to be modified based on the evidence and feedback from anesthesia and registered nurses. Monthly reports ensure consistency.