ERAS pathways

Implementation of multidisciplinary approached evidenced-based ERAS pathways in perioperative care


Background information: ERAS, a multidisciplinary approached evidenced-based perioperative care pathway, is designed to optimize perioperative care (from indication to 30-days postoperatively) in order to maintain organ function, optimize prehabilitation, reduce perioperative physiological stress and facilitate early mobilization.

Aim and relevance of the initiative: The aim of this implementation is to improve patients outcome by using evidence based perioperative care elements to form a care protocol and interactively auditing the patients outcome in an ERAS interactive audit system (EIAS). The enhanced recovery after surgery program is an innovative initiative which is not only beneficial for our most important stakeholder, the patient, but also to all stakeholders in patient care, healthcare providers and society. Implementation results in a significant decrease in complications, less re-operations and re-admissions and enhance survival for less cost than traditional perioperative care.

Setting: ERAS is implemented in our hospital in the colorectal and urological surgical disciplines and will be expanded in other surgical specialities.

Patient description: ERAS, a multidisciplinary approached evidenced-based perioperative care pathway, is designed to optimize perioperative care (from indication to 30-days postoperatively) and is applicable for many surgical disciplines and implemented in our hospital for colorectal, urological en gynaecology surgery.

Methods: These outcomes are analyzed and evaluated in EIAS in order to monitor the compliance to the implemented evidence based care protocols and discuss the results of these implemented protocols on patients outcome in a detailed manner. This detailed analysis shows where the real problems in patient care are and which element might be improved in order to further improve the quality of care and outcome. This is an important and real time feedback loop to address the real problems in this care pathway in order to learn and solve these problems to improve outcome.  The analysis of the patients outcome is based on evaluating the implemented evidence- based perioperative care elements summarized in evidence based ERAS protocols. In this evidence-based care pathway the most important stakeholder is the patient and the goal of any kind of optimalisation of any element of ERAS flows back directly to patients care. In order to implement changes needed to improve patient care we are using the Breakthrough methodology to achieve this.

Size and scope: The ERAS pathways can be applied on several surgical disciplines and have a major impact on the improvement of the quality of patient care.

Most important results: The implementation of ERAS pathways resulted in a decrease in perioperative complications (40%), reduction in length of stay (2.5 days), a decrease in re-admissions and re-operations (5,3 → 2.4 %), less stoma (50%) and a reduction in ICU admissions (0.7→ 0.2 days) and improved survival. Significant reduction in health care costs (> €1250/patient) were achieved after fully implemented ERAS pathways. Therefore, we can provide better care for less costs!

Collaborations and Partnership: Implementation of ERAS resulted in several collaborations with other professional organizations and stakeholders. The main stakeholders are any specialty involved in the whole pathway of care. Each stakeholder is responsible for their specific contribution to the patients journey in the perioperative pathway.