Best practice

Enhanced recovery after surgery program at UH recognized with Patient Engagement Best Practice Award

An innovative program at University Hospitals (UH) is yielding notable results, creating shorter hospital stays, less use of opioids, fewer post-surgical infections and lower costs for patients, according to a news release.

Enhanced Recovery After Surgery (ERAS) first was implemented at UH Cleveland Medical Center and now is in use at all hospitals across the UH system.

The protocol recently won the Patient Engagement Best Practice Award from the Ohio Patient Safety Institute for 2021.

Key elements of Enhanced Recovery After Surgery at UH include:

• Pre-operative counseling to set expectations with patients and families

• Optimizing pre-operative and post-operative nutrition

• Minimizing the use of narcotic pain relievers after surgery

• Promoting early mobility after surgery; getting patients up and walking as soon as possible

“Undergoing surgery is basically like running a marathon,” said Heather McFarland, system director of the Anesthesia Value Network and vice chair of clinical operations.

McFarland leads the Enhanced Recovery After Surgery project at UH, along with Soozan Abouhassan, MD, a critical care anesthesiologist, and Ronald Charles, MD, a colorectal surgeon.

Each surgery patient at UH receives an Enhanced Recovery After Surgery kit mailed to their home before surgery, customized for his or her particular needs, according to the release.

UH absorbs the cost of the kit — patients are not charged, the release said.

It may include high-protein nutritional drinks for the days pre- and post-surgery, carbohydrate-loading drinks for the night before and morning of surgery, exercise bands and instructions developed by UH physical therapists, a pedometer, incentive spirometers and additional education material about surgery.

UH assembled a team of physicians to create and implement new Enhanced Recovery After Surgery guidelines in early 2020, and so far, the protocols have made a measurable difference for UH patients, the release said.

“All of these efforts have contributed to a decreased length of stay for our ERAS patients,” Abouhassan said. “Decreased narcotic usage is under way by increasing the use of nerve blocks and multimodal therapy.

“Post-operative narcotic usage is down by more than 60 percent. Evidence for surgical site infections and readmissions demonstrate a positive downward trend.”

Service lines at UH employing Enhanced Recovery After Surgery currently include colorectal, cardiac, gynecology, obstetrics, orthopedics, thoracic, general surgery specialties, plastics, ENT, transplant and urology.

“We are quite comprehensive,” Charles said. “Many hospitals have one service line, maybe two participating in ERAS.

“It’s unique and notable for a hospital system to take an initiative, where the entire organization is moving toward that direction. We’re currently helping even more surgery service lines adopt

ERAS protocols.”

UH is moving toward a national Enhanced Recovery After Surgery certification by the end of the year.

Once certified, UH will be one of just five Enhanced Recovery After Surgeryqualified centers in the U.S., according to the release.

“This program allows our patients to be active participants in their care, which gives them a sense of calmness and helps alleviate any anxiety they may have going into surgery,” McFarland said. “We’re happy to be recognized for our implementation of this program, but even happier to see that it’s helping patients and leading to optimal outcomes.”