Johns Hopkins has had success with using the Enhanced Recovery After Surgery (ERAS) protocols to improve post-op care, and now it is helping 750 hospitals adopt them.
ERAS protocols are multimodal perioperative care pathways designed to promote early recovery after surgical procedures by maintaining organ function and reducing the stress response following surgery. Advocates say ERAS can reduce complications, decrease lengths of stay in the hospital, and increase the overall patient experience. (See the story in this issue for research on the effects of ERAS.)
ERAS is used at the Johns Hopkins Hospital in Baltimore. The Johns Hopkins Armstrong Institute for Patient Safety and Quality, working with the American College of Surgeons (ACS), has been granted a multimillion dollar contract to implement ERAS protocols in 750 hospitals across the United States. The grant is funded by the Agency for Healthcare Research and Quality. Phase one is focusing on abdominal operations in colorectal surgery. Future projects will focus on bariatric surgery, orthopedic surgery, gynecology, and emergency general surgery.
ERAS is widely used in Europe and Canada, but American hospitals have been slow to adopt it, says Michael Rosen, MA, PhD, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, and an associate professor with the Armstrong Institute. The program addresses many issues that top concerns for hospitals now, including readmission, complications, and cost effectiveness, he notes.
Hopkins began recruiting hospitals in March and will begin with the first cohort this summer.
Some hospitals are implementing pieces of ERAS but not the whole program, Rosen notes. The protocol challenges some widely held assumptions about what results in the best recovery after surgery, so clinicians must understand the research behind it and the benefit if it is to be successfully introduced in a hospital, Rosen says. Though the goal is a quick and healthy recovery, he points out that ERAS does not affect just the post-op care of the patient.
“The protocols apply from the time the decision to have surgery is made to the days leading to surgery, pre-op, intra-op, recovery, step down, and discharge,” Rosen says. “It affects the whole perioperative service line. So, adopting ERAS is more all-encompassing than programs that affect mainly the intraoperative time, for instance. Changes have to be made all along the continuum of care.”
ERAS pathways are tailored for the particular type of surgery. The benefits of ERAS have been well proven in Europe, Rosen says. He strongly advocates adopting the program, but cautions that it is a significant commitment.
“It’s a lot of work, a real challenge. Change in any organization is tough, and change in a healthcare organization is especially tough because it’s technically and culturally complex.” Rosen says. “Without a doubt, this involves a lot of work for hospitals. Our program is a 15-month cohort that starts with education and analysis, along with starting a team that ideally is led by surgeons, anesthesiologists, nurses, and administrators.”
ERAS protocols are appropriate for all types of hospitals providing surgical services, Rosen says. Hospitals within the United States and Puerto Rico are eligible to participate. Participating hospitals will have access to leaders in ERAS, including representatives of surgery, anesthesiology, and nursing, along with prototype ERAS protocols developed for the five procedures based on up-to-date evidence review. They also will receive literature to support the protocols, tools and educational materials to facilitate implementation, quality improvement specialist support, and coaching calls to support hospital work.
To sign up or for more information, contact ACS at
[email protected].
