A surgical protocol called Enhanced Recovery After Surgery (ERAS) has been shown to significantly improve patient satisfaction and outcomes. The protocol focuses on a few key strategies outlined in this article. Overhauling processes to ERAS compliance is a huge undertaking. However, there are some concepts in ERAS that every ASC can start using right away to increase patient satisfaction and improve outcomes.
Understanding the protocol
ERAS protocol is complex and involves optimization at the pre-hospital, preoperative, intraoperative, postoperative, and post-discharge stages. The key elements are summarized as follows:
- Pre-hospital phase focuses on patient and family education, a clear pain management plan, patient optimization, and prehabilitation of qualifying patients.
- Preoperative phase includes limiting fasting where patients consume a light meal up to 6 hours before surgery; a carbohydrate beverage up to 2 hours before surgery; discharge planning and a home medication plan; and initial multimodal medications or regional block placement.
- Intraoperative phase involves opioid sparing and multimodal analgesia, normovolemia, normothermia, normoglycemia, nausea/vomiting prophylaxis, and avoidance of tubes or drains
- Postoperative phase includes early nutrition and mobilization, management of nausea or vomiting, multimodal analgesia, patient and family education, and no or judicious IV fluid management.
- Post-discharge phase includes follow-up care, continued therapy, and monitoring for symptoms or changes in health.
Research shows that adherence to ERAS improves patient satisfaction and outcomes and reduces the cost of care.
Using ERAS in an ASC
Some experts note that, in the past, healthcare providers often looked only to technology to improve health. However, now surgeons and clinicians are looking at their care processes to improve outcomes. Changing processes is challenging work. But better protocol can go a long way in helping your patients.
One component of using ERAS methods in an ASC setting is determining if a patient is in good enough condition to be a candidate at all for outpatient surgery. Although many operations can now be done on an outpatient basis, patients must have enough support at home to recover properly. ERAS asks providers to look at all aspects of a patient’s health, including psychological and social wellness. Psychological or social barriers can make a significant impact on a patient’s recovery.
Another aspect of ERAS is pre-operative optimization. Make sure that your ASC is providing educational resources at every stage in a patient’s care. Send text messages or email reminders to ensure pre-op protocol compliance. Communicate again after discharge to ensure proper follow-up care. Using a mix of video, text message, email, and phone calls can improve the patient experience as well as increase compliance.
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