Dr. Tonia Young-Fadok was always looking for innovative ways she and her colleagues at the Mayo Clinic in Phoenix could improve the quality of care for their colon and rectal surgery patients.
Their patients' lengths of stay and outcomes were on par with other high-performing hospitals, said Young-Fadok, who chairs the division of colon and rectal surgery. Still, she thought they could do better.
Then, several years ago at a conference in Oklahoma, Young-Fadok had a conversation that led her to champion radical changes to surgical practices that had been standard at her hospital and most others for decades. That conversation was with one of the leaders of the Enhanced Recovery After Surgery (ERAS) Society, a Sweden-based group that promotes evidence-based protocols to improve surgical care and speed recovery.
Young-Fadok said she initially was wary because other surgical streamlining efforts had been linked to higher readmission rates. “But I realized the evidence was there,” she said.
Created in the mid-1990s by a Danish surgeon, ERAS protocols aim to make surgery less physically debilitating for patients so they can leave the hospital sooner. Enhanced recovery has been shown in trials to improve lengths of stay and outcomes, and curb costs. Many European hospitals now use enhanced recovery protocols. But only a few U.S. hospitals have implemented them.
Many key ERAS protocols turn usual practices on their head. For instance, instead of fasting after midnight the night before surgery, patients are allowed to have a clear drink such as apple juice up to two hours before the procedure. They receive far less IV fluids and narcotics during and after surgery. They are encouraged to get up and walk around soon after the operation instead of lying in bed for several days. And they are allowed solid foods on the day of surgery, provided they tolerate fluids first.