CLEVELAND -- The colorectal surgery service line at University Hospitals was recently certified as a Qualified Center for Enhanced Recovery After Surgery (ERAS) by the ERAS® Society at the fifth annual ERAS Congress in Washington, DC – one of fewer than 10 such centers in the United States.
ERAS is an evidence-based protocol that includes 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 and promoting early mobility after surgery.
Colorectal surgery is one of 14 service lines that have adopted ERAS® at UH, with more to come. Already, the ERAS program at UH has produced notable results, creating shorter hospital stays, less use of opioids, fewer post-surgical infections and lower costs for patients. In fact, the ERAS protocol at UH has resulted in a 63 percent reduction in narcotics prescribed at discharge.
Cardiac, colorectal and spine surgery patients at UH receives an ERAS kit mailed to their home before surgery, customized for their particular needs. UH absorbs the cost of the kit – patients are not charged. 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.
The protocol first implemented at UH Cleveland Medical Center and now in use at all hospitals in the UH system recently won the Patient Engagement Best Practice Award from the Ohio Hospital Association and the Ohio Patient Safety Institute for 2021. It was also an important factor in UH being honored with the American Hospital Association’s Quest for Quality Award in 2022 – the organization’s highest honor.
“Up to 30 percent of patients having surgery suffer a preventable complication,” said Heather McFarland, DO, System Director of the Anesthesia Value Network and Vice Chair of Clinical Operations. She leads the ERAS project at UH, along with Soozan Abouhassan, MD, a critical care anesthesiologist, Ronald Charles, MD, a colorectal surgeon, Naomi Compton, BSN, RN, ERAS Nurse Coordinator, and Magdalen Canitia, ERAS Operations Data Analyst. “This increases mortality, suffering, length of stay, costs. We can eliminate this by the broad use of ERAS programs. ERAS empowers patients to take a more active role in their pre-surgery care and post-surgery recovery.”
Drs. McFarland, Abouhassan, Charles and Nurse Coordinator Compton presented UH patient data at the ERAS Congress, including providing the keynote presentation for the conference. Their results show that patients undergoing colorectal surgery at UH Cleveland Medical Center under the ERAS protocol had decreased days until the return of bowel function, decreased variable cost, decreased length of stay and decreased readmissions. In addition, spine surgery patients following the ERAS protocol had decreased length of stay and decreased costs, while cardiac surgery patients had decreased length of stay, decreased costs and decreased readmission, compared with patients not following the ERAS protocol.
The ERAS team at UH attributes their success to an approach that disseminates best practices widely to every corner of the health system – what they describe as “fractal management.” In addition, they credit a Zero Harm culture where caregivers are empowered to take action.
“Without an amazing team surrounding this initiative, we couldn’t have accomplished this designation and produced the results,” Dr. McFarland said. “We thank our executive leadership, our operations teams, and the numerous surgeons, anesthesiologists, nurses, and ancillary staff that take care of our patients every day.”
“ERAS is a patient-centered and evidence-based approach to surgery that has reduced length of stay and costs, improved pain scores and quality and reduced narcotics use,” added Peter Pronovost, MD, PhD, Chief Quality and Clinical Transformation Officer at UH. “Because we integrated ERAS with our efforts into clinical transformation, we have spread this approach across all of our 21 hospitals and 14 service lines. At UH, it is the way we delivery surgical care with great outcomes.”
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About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of more than 20 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Oxford University and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.