From the time a surgeon decides to operate until the time a patient is discharged after a procedure, hospitals that use enhanced recovery after surgery protocols—or ERAS—are able to reduce complications, decrease lengths of stay in the hospital, and increase the overall patient experience.
The Johns Hopkins Armstrong Institute for Patient Safety and Quality, in collaboration with the American College of Surgeons, has been granted a multimillion dollar contract to implement those ERAS protocols in 750 hospitals across the United States.
"With the success of ERAS at our hospital, we are excited to share this approach with other hospitals," says Michael Rosen, an associate professor with the Armstrong Institute. "This will be an important step in improving patient care throughout their surgery process."
The grant, funded and guided by the Agency for Healthcare Research and Quality, includes nearly $4 million in phase one to focus on abdominal operations in colorectal surgery. The grant includes a phase two option, which would increase funding to $12 million over three years and focus on bariatric surgery, orthopedic surgery, gynecology, and emergency general surgery.
Fundamental to successful ERAS protocols is a collaborative approach to care. ERAS protocols require close coordination among surgeons, anesthetists, and nurses, and include patient and family engagement, avoiding prolonged fasting periods, prescribing and using opioids sparingly, and incorporating multiple methods to control pain.
Johns Hopkins transformed the implementation of these protocols in 2013, when Elizabeth Wick, who is now an adjunct associate professor of surgery at the Johns Hopkins University School of Medicine, combined ERAS with the Comprehensive Unit-based Safety Program. The CUSP program engages health care staff members in preventing harm, and the combination of the initiatives has led to a decrease in hospital stay, costs, and infections.
"Too often, patients suffer complications and prolonged hospitalizations after surgery, although the steps to prevent these results are known," says Peter Pronovost, director of the Armstrong Institute and senior vice president of patient safety and quality for Johns Hopkins Medicine. "This program brings these recommended practices together into one coordinated, unified program where everyone—clinicians, patients and their loved ones—understand what they must do for the best possible outcome."Read more from Hopkins Medicine
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