Implementation of Enhanced Recovery After Surgery in a Community Hospital: An Evidence-Based Approach

Purpose: Enhanced recovery after surgery (ERAS) is an evidence-based practice protocol that has been shown to reduce cost, decrease length of stay (LOS), and improve surgical outcomes. Design: An evidence-based practice improvement project with a multidisciplinary team translated the ERAS protocol into practice at a community hospital. The evidence-based practice improvement design allows integration of evidence into projects to improve clinical outcomes for patients. Methods: Small tests of change using the Plan-Act-Study-Do methodology were used to evaluate the process of implementing one surgical service at a time to ensure effective outcomes. After the process was determined to be effective, patient outcomes (eg, LOS) were measured. Findings: On average, LOS was decreased from 3.2 to 1.7 days. Surgical readmission rate decreased from 3% to 1%. There has been positive feedback and nursing workload has decreased with consistent processes. Conclusions: The ERAS order set continues to be modified based on the evidence and feedback from anesthesia and registered nurses. Monthly reports ensure consistency.