Helping Hospitals Improve the Safety of Patients Undergoing Surgery
Millions of surgeries are performed every year in U.S. hospitals. Patients generally assume that their surgeries will go as planned, and they usually do. But good outcomes aren't guaranteed, even for routine procedures. Infections, reactions to pain medication, or other complications can occur—and when they do, a cascade of negative consequences can result.
AHRQ—with a long history of funding patient safety research and developing tools to keep patients safe—is committed to helping clinicians prevent these persistent problems. That's why we’ve launched a new multi-year project, called Enhanced Recovery After Surgery, or ERAS, which will give hospitals and their medical teams the tools they need to minimize these dangerous and costly complications.
ERAS, originally developed in Europe in the 1990s, has attracted interest in the United States based on studies and meta-analyses demonstrating successful results. It emphasizes a collaborative care approach, involving close teamwork among surgeons, anesthesia providers, and nurses. As described in the project, ERAS is based on a multi-pronged approach to supporting patients who undergo surgery:
- Restore normal physiology as quickly as possible
- Provide coordinated, high-quality care in all aspects of the patient encounter, before, during, and after surgery
- Improve patient communication and engagement
- Integrate evidence-based practices.
Important elements of ERAS include making sure that patients avoid prolonged fasting periods, avoiding excess fluid administration, and prescribing and using opioids sparingly by incorporating multiple methods to control pain, such as using non-steroidal anti-inflammatory drugs.
In the AHRQ-funded ERAS project, the Agency is working with the Johns Hopkins Armstrong Institute for Patient Safety and Quality, which will collaborate with the American College of Surgeons to enroll 750 hospitals to implement the ERAS protocol. Hospitals' initial efforts will focus on improving patients’ recovery from colorectal surgery, which has been the focus of multiple ERAS studies because of its relatively higher risk of complications. Additional efforts may focus on orthopedic, bariatric, gynecologic, and emergency surgery.
ERAS is the latest in a long line of projects that AHRQ supports to improve patient safety. The most prominent of these is the Comprehensive Unit-based Safety Program, or CUSP. CUSP is a multifaceted approach that speeds front-line clinicians' adoption of evidence-based practices to reduce patient harm. In a 4-year nationwide rollout of CUSP, intensive care units lowered central line-associated bloodstream infections by 41 percent. Building on this success, AHRQ has adapted CUSP to reduce other healthcare-associated infections in other care settings.
We're now taking this one step further. Starting in 2013, Johns Hopkins Hospital tested an intervention that used CUSP practices along with ERAS. Combining these two approaches, the hospital saw impressive safety improvements for colorectal surgery patients: surgical-site infections declined by more than 50 percent, average lengths of stay dropped by 1.9 days, and per patient costs were reduced by more than $1,800.
We believe that these kinds of gains can be realized more widely. Elements of ERAS have already proven successful in reducing surgical-site infections and lung infections, according to a recent meta-analysis published in the Annals of Surgery.
The evidence to date convinces us that ERAS is right for patients. Developing strategies to make care safer for patients, and then helping clinicians implement them, are at the heart of what AHRQ does. So stay tuned as we move forward to spread the use of ERAS across the country. It promises to contribute significantly to the safety and wellbeing of patients undergoing surgery.
Dr. Cleeman is Director of AHRQ’s Healthcare-Associated Infections Program within the Agency’s Center for Quality Improvement and Patient Safety.
Page originally created March 2017