Optimizing Outcomes with Enhanced Recovery
The term “enhanced recovery pathway (ERP)” refers to a multimodal approach to patient care, based on interdisciplinary work that contributes not only to the standardization of care but also to increase quality, while containing cost. ERPs are implemented
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Key Concepts • Enhanced recovery pathways (ERPs) include measures for preoperative management, intraoperative care, postoperative recovery, and pathway quality evaluation. • ERP improves the quality of patient care by establishing standardized care paths based on evidence-based literature and current practice guidelines. • A modified frailty index (MFI) allows for preoperative risk stratification and identifies patients that will require extra healthcare resources. • A combination of oral antibiotics administered during the preoperative phase combined with intravenous antibiotics administered within 1 h of surgery appears to be the most efficacious strategy to decrease SSI. • Measurement of ERP compliance is necessary to make sure the individual stated pathway items are being accomplished.
Introduction Among the goals of a successful surgical practice, delivering high-quality patient-centered care while maintaining a low procedure-specific morbidity and readmission rate is of paramount importance. Facilitating a patient’s recovery and assisting them to return to their usual activities safely, but also as soon as possible, should be viewed as part of these goals [1]. Accomplishing these goals benefits not only patients, but by decreasing length of hospital stay (LOS) and costs associated with diagnosis and treatments of complications, they also help to improve the efficiency with which healthcare is provided [2–5]. In the era of bundled payment, “pay for performance,” and ongoing cuts in healthcare reimbursement, decreasing hospital operating expenses may contribute to increasing or at least maintaining hospitals’ financial viability [6]. Costanalysis data demonstrating that a specific healthcare system
is able to deliver comparable patient care at a lower cost may also influence insurance preference to established contracts with a specific healthcare system over another. Minimally invasive techniques have had a major impact on postoperative recovery, contributing to a reduction in LOS and cost [6]. In many subspecialties, these techniques have now substituted open operations and become the standard of care. However, optimizing patient recovery goes far beyond a particular technical approach. It requires a multidisciplinary approach that includes not only surgeons, anesthesiologists, and nurses, among others but also the patient himself. Enhanced recovery protocols (ERPs) start at the surgeon’s office by engaging the patients in this process, managing expectations, and converting them from a passive recipient of care into an active member of this recovery team. Standardization of perioperative care measures combined with minimally invasive colorectal surgery has decreased, in our hands, LOS to an average of 2.6 days, without a significant impact on readmission rate [7–12].
What Is an ERP? Traditionally, pre-, intra-, and postoperative management had varied depending on individuals’ practice preferences of the various members of the healthcare team involved. This approach creates significant variability throughout
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