Introduction
What is Enhanced Recovery?
A multimodal perioperative care pathway, designed to achieve early recovery for patients undergoing major surgery. The Enhanced Recovery pathway encompasses all stages of a patient’s surgical experience—pre-operative, intra-operative and post-operative—and depends on a collaborative effort from all perioperative health care providers.
Enhanced Recovery is a paradigm shift that allows clinicians to re-evaluate traditional practices and employ evidence based guidelines. Enhanced Recovery is not research, it’s goal is not to ascertain new knowledge, but rather to utilize established recommendations and standardize care. Enhanced Recovery eliminates the variability in care delivered, ensuring that all patients are receiving the highest quality of care here at UNC
Why should we use Enhanced Recovery pathways?
Numerous clinical studies have demonstrated that enhanced recovery after surgery clinical pathways:
- Improve patient outcomes and satisfaction with their care
- Decrease perioperative morbidity and mortality
- Decrease hospital length of stay
These outcomes have also been observed at UNC since our implementation.
Benefits of Implementation and Sustainability
The successful implementation of Enhanced Recovery pathways is contingent on the collaboration between various health care teams and services. Importantly, despite requiring a multidisciplinary approach, the prevailing consensus from numerous studies suggests that Enhanced Recovery pathways will decrease the overall utilization of hospital resources. Enhanced Recovery pathways have been demonstrated to alleviate ancillary service workload, with some studies citing a 39% reduction in total time spent in nursing activities.
The sustainability of ERAS protocols is further underlined by preliminary studies that have suggested that these programs are more cost-effective than traditional care. Interestingly, there are a number of outcomes that demonstrate no differences in the utilization of health care resources between ERAS and traditional pathways. To elaborate, when comparing ERAS to traditional protocols, no significant differences have been observed with respect to surgery duration, readmission rates, and post-operative use of primary care services.
Patient Safety and Quality Improvement
Enhanced Recovery is a part of the Department of Anesthesiology’s Patient Safety and Quality Improvement division. It is governed by the principle that quality in healthcare is:
“The right care for the right person at the right time, the first time.” – Carolyn Clancy, Director, Agency for Healthcare Research and Quality
The Six Aims for Quality Improvement
1. Safety:
Avoiding Injuries to patients from the care that is intended to help them. Patients ought to be as safe in health care facilities as they are in their own homes.
2. Effectiveness:
Providing scientific knowledge-based services to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively). The health care system should match care to science, avoiding both overuse of ineffective care and underuse of effective care.
3. Patient-Centeredness:
Providing care that is respectful of, and responsive to, individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Health care should honor the individual patient, respecting the patient’s choices, culture, social context, and specific needs.
4. Timeliness:
Care should continually reduce waiting times and delays for both patients and those who give care.
5. Efficiency:
The reduction of waste should be never-ending, including, for example, waste of supplies, equipment, space, capital, ideas, and human spirit.
6. Equity:
Providing care that does not vary in quality because of personal characteristics. The system should seek to close racial and ethnic gaps in the health status.