The Power of an ERAS Protocol Checklist
Recently, I spoke with a physician leader championing the implementation of Enhanced Recovery After Surgery (ERAS protocols) across an 11-hospital system.
What is ERAS Protocol?
The ERAS protocol emerged as a clinically-valid, patient-centric rethinking of the standard surgery experience 15-plus years ago. Over 4,000 articles have been published in the medical literature to support the extensive benefits of this approach.
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Why isn’t it more widely adopted?
The physician leader felt perplexed. The providers in his hospitals did not use the ERAS protocol in their practices. Why not move from a standard instruction to avoid eating and drinking after midnight the night before surgery? Evidence indicates that patients do better in surgery and recovery with a more tailored approach. This modified fasting allows clear, carbohydrate-rich fluids up to two hours before a procedure. Had the doctors missed the literature?
So he asked them.
It turns out, they knew the literature surrounding ERAS protocol. They just didn’t think the guidelines applied in their setting. Also, they didn’t believe their patients would be capable of following these more nuanced instructions. Further, the healthcare system doesn’t support providers and patients who use updated approach to surgery. And, in the absence of systematic support, only professional judgement remains.
A Simple Solution: An ERAS Protocol Checklist
Rather than suggest a solution as complex as the problem, we’d like to suggest something simple. We believe An ERAS protocol checklist represents a small portion of a solution. It has been almost a decade since Atul Gawande, MD, released The Checklist Manifesto. The book features an alluring idea: What if the medical innovation we need isn’t a groundbreaking new drug or whiz-bang technology. What if it’s a standard operating procedure, a modest checklist?
Checklists first rose to prominence as a safeguard for keeping gigantic airplanes in the sky. A checklist solved easily-overlooked yet critically-important steps in successfully in flying a new model of plane. Checklists have been deployed to similarly dramatic effect in healthcare. They cut infection rates, reduced patient pain and suffering, and saved lives. ERAS protocols represent one category of checklists. But it’s an important category designed to optimize the surgery and recovery experience for patients.
The Ease of Checklists
To put it bluntly, checklists make screw-ups less likely. What are the common screw-ups in surgery? Infections and complications that lead to reoperations headline the list. But what about failing to give a patient information widely known to improve his or her surgical experience? Say, for instance, instructions about eating and drinking prior to surgery? Or pain management? Or procedural options?
These process-oriented screw-ups amount to issues equal to, if not more troubling than, outcomes-oriented measures more commonly reported today. They lead to opioid addiction. And they lead to unnecessarily long post-surgical recovery. They also lead to substantial economic costs and waste. A checklist that implements the ERAS protocol can change that when it comes to surgery.
The idea of checklists has been with us for nearly 100 years. They can keep planes out of trouble. So they can also keep your loved ones, your coworkers, your plan’s members and others from experiencing bad surgical outcomes as well.