Enhanced recovery protocols, designed to improve postoperative outcomes


As states begin to reopen amid the COVID-19 pandemic and hospitals ramp up elective surgeries, it is crucial hospitals do all they can to strengthen and improve postoperative outcomes. As a result, more hospitals are exploring or have implemented enhanced recovery protocols. These protocols are designed to help reduce the stress on a patient’s body and enable faster recovery after surgery by reducing opioid use, surgical site infections, hospital length of stay, and improving overall postoperative outcomes, which can ultimately lead to a better overall patient experience and lower hospital costs.

During a June 25 webinar sponsored by Cardinal Health and hosted by Becker's Hospital Review, clinicians discussed what enhanced recovery protocols are and how they improve the patient’s perioperative experience and the hospitals postoperative outcomes.

The clinicians were:

  • Tina Keller, BSN, CNOR, Sr. Clinical Consultant, Cardinal Health
  • Tracy Smith, PHD, RD, LB, National Clinical Liaison, Abbott Nutrition

Five key takeaways from their discussion: 

  1. The history of enhanced recovery protocols goes as far back to the 90s and early 2000s. The ERAS® Society was formed in 2001 to establish evidence-based protocols with the goal of reducing the stress of surgery on a patient’s body. Although not only specific to the ERAS® society, enhanced recovery protocols have become more widely used in the U.S. over the last five years, according to Mrs. Keller. These multimodal protocols are designed with the patient as the central focus of their collaborative, perioperative journey by engaging them in the process of achieving optimal results after surgery.

  2. Proper perioperative nutrition is a key element of enhanced recovery protocols. Over 20 years ago in 1999, the American Society of Anesthesiologists issued guidelines to allow clear liquids up to 2 hours before anesthesia for elective procedures undergoing general or regional/local anesthesia.

    "Today however," Dr. Smith stated, "Nutrition is often not top of mind and can be overlooked. But there are multiple positive outcomes that have shown with perioperative nutrition: reduced length of stay and reduced infections and complications, which can lead to an enhanced patient experience. Good nutrition can benefit all patients and is not just for patients who are malnourished."

    For example, nutrition before surgery can provide a large amount of energy a patient needs during surgery. More specifically protein, arginine and omega-3 fatty acids support the immune system and can help reduce surgical stress. 

  3. Reducing the use of opioids is one important driver behind why some hospitals adopt enhanced recovered protocols. In 2017, more than 64,000 people died of drug overdoses. By using multimodal analgesia, providers can standardize care and improve outcomes while providing satisfactory postoperative pain control. The multimodal approach begins by using acetaminophen and/or NSAIDs and local injections or blocks, and advances to low-dose opioids if needed. 

  4. Data shows that enhanced recovery protocols are making an impact. Examples of protocol success at a small hospital, Mrs. Keller cited, included the decrease of postoperative opioid use by 58 percent, anti-emetic drug use by 61 percent and hospital length of stay by 13 percent which yielded an estimated annual savings of $200,000. Another example used was the 90-day readmission rate at a community hospital, going down from 4.8 percent to 3.1 percent.

  5. The four key challenges to adopting ERAS protocols based on research include internal buy-in, compliance, partial adoption and auditing results. According to Mrs. Keller, "Organizations must have a clear desired outcome. To attain those outcomes key stakeholders and champions, including a nutrition champion, must be identified. Collaboration helps support internal buy-in and drive compliance."

    The next critical step is coordinating across departments to avoid silos where one department was implementing enhanced recovery protocols and other departments were unaware. Mrs. Keller stated, "To drive consistent coordination, many hospitals have hired enhanced recovery coordinators to consolidate education, communication, products, and third-party vendor relationships that support building the perioperative product packs and getting them to the patients, which can help save on time and cost."

    Communication is the third step. According to Mrs. Keller, communication can make or break a programs ability to launch and succeed. Ensuring there is ongoing education of both staff and patients throughout the program implementation is key. It is also imperative to track what's working and what's not working so teams can adjust methods.

    "This is what it’s all about, optimizing outcomes for our patients. And to do that, it is a combined effort between the patient, the surgeon, hospital staff, hospital leaders and third-party partners," Mrs. Keller said.

To view the full webinar, click here. To learn more about how Cardinal Health can best support your enhanced recovery protocol(s), click here

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