University Hospitals One of Fewer Than 10 Sites Nationwide to Earn Designation as Qualified Center for Enhanced Recovery After Surgery

Protocol is creating shorter hospital stays, less use of opioids, fewer post-surgical infections and lower costs for patients

UH Clinical Update | December 2022

The colorectal surgery service line at University Hospitals was recently certified as a Qualified Center for Enhanced Recovery After Surgery (ERAS) by the ERAS® Society at the fifth annual ERAS Congress in Washington, DC – one of fewer than 10 such centers in the United States.

ERAS is an evidence-based protocol that includes 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 and promoting early mobility after surgery.

Colorectal surgery is one of 14 service lines that have adopted ERAS® at UH, with more to come. Already, the ERAS program at UH has produced notable results, creating shorter hospital stays, less use of opioids, fewer post-surgical infections and lower costs for patients. In fact, the ERAS protocol at UH has resulted in a 63% reduction in narcotics prescribed at discharge.

Cardiac, colorectal and spine surgery patients 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.

The protocol first implemented at UH Cleveland Medical Center and now in use at all hospitals in the UH system recently won the Patient Engagement Best Practice Award from the Ohio Hospital Association and the Ohio Patient Safety Institute for 2021. It was also an important factor in University Hospitals being honored with the American Hospital Association’s Quest for Quality Award in 2022 – the organization’s highest honor.

“Up to 30% of patients having surgery suffer a preventable complication,” says 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, Ronald Charles, MD, a colorectal surgeon, Naomi Compton, BSN, RN, ERAS Nurse Coordinator, and Magdalen Canitia, ERAS Operations Data Analyst. “This increases mortality, suffering, length of stay, costs. We can eliminate this by the broad use of ERAS programs. ERAS empowers patients to take a more active role in their pre-surgery care and post-surgery recovery.”

Dr. McFarland, Dr. Abouhassan, Dr. Charles and Naomi Compton presented UH patient data at the ERAS Congress, including providing the keynote presentation for the conference. Their results show that patients undergoing colorectal surgery at UH Cleveland Medical Center under the ERAS protocol had decreased days until the return of bowel function, decreased variable cost, decreased length of stay and decreased readmissions. In addition, spine surgery patients following the ERAS protocol had decreased length of stay and decreased costs, while cardiac surgery patients had decreased length of stay, decreased costs and decreased readmission, compared with patients not following the ERAS protocol.

The ERAS team at UH attributes their success to an approach that disseminates best practices widely to every corner of the health system – what they describe as “fractal management.” And they credit a Zero Harm culture where caregivers are empowered to take action.

“Without an amazing team surrounding this initiative, we couldn’t have accomplished this designation and produced the results,” Dr. McFarland says. “We thank our executive leadership, our operations teams, and the numerous surgeons, anesthesiologists, nurses, and ancillary staff that take care of our patients every day.”

“ERAS is a patient-centered and evidence-based approach to surgery that has reduced length of stay and costs, improved pain scores and quality and reduced narcotics use,” adds Peter Pronovost, MD, PhD, Chief Quality and Clinical Transformation Officer at UH.  “Because we integrated ERAS with our efforts into clinical transformation, we have spread this approach across all of our 21 hospitals and 14 service lines. At UH, it is the way we delivery surgical care with great outcomes.”