Enhanced Recovery After Surgery Program at UH Recognized with Patient Engagement Best Practice Award

CLEVELAND – 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. Enhanced Recovery After Surgery (ERAS) was first implemented at UH Cleveland Medical Center and is now 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 ERAS 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, DO, FASA, 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, and Ronald Charles, MD, a colorectal surgeon. “ERAS empowers patients to take a more active role in their pre-surgery care and post-surgery recovery.”

Each surgery patient at UH receives an ERAS kit mailed to their home before surgery, customized for his or her 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.

UH assembled a team of physicians to create and implement new ERAS guidelines in early 2020, and so far, the protocols have made a measurable difference for UH patients.

“All of these efforts have contributed to a decreased length of stay for our ERAS patients,” said Dr. Abouhassan. “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 ERAS currently include Colorectal, Cardiac, Gynecology, Obstetrics, Orthopedics, Thoracic, General Surgery Specialties, Plastics, ENT, Transplant and Urology.

“We are quite comprehensive,” said Dr. Charles. “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 ERAS certification by the end of the year. Once certified, UH will be one of just five ERAS-qualified centers in the U.S.

“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,” said Dr. McFarland. “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.”