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ACS and Johns Hopkins aim to cut surgery stays in half with $16 million study

by John W. Mitchell , Senior Correspondent
The American College of Surgeons and Johns Hopkins Armstrong Institute for Patient Safety and Quality are looking for 750 hospitals that are willing to radically shake up the way they deliver surgical care.

The two organizations are undertaking an initiative with $4 million in startup money from a government quality agency with up to $16 million in total funding possible over the next three years.

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The Enhanced Recovery After Surgery (ERAS) protocols achieved 30-50 percent shorter surgical recovery times, improved safety, and lower costs in more than 20 countries, according to an article published last month in the Journal of the American Medical Association Surgery.

"To achieve these outcomes, practices within a facility need to change," Michael Rosen, Ph.D., associate professor of Anesthesiology and Critical Care Medicine at Johns Hopkins told HCB News. "Changing behavior in any organization is difficult, and doubly so for complex technical organizations, like surgical services."

To achieve such a change in surgical outcomes, the participating hospitals will have to make a five-step cultural change using ERAS protocols. This requires engaging front line, hands-on caregivers to think critically about the way they do their work and make evidence-based changes. Some of the examples cited in the JAMA article included: changes in overnight fasting; eliminating or early removal of drains and tubes; getting patients up on their feet sooner; and changes to nutrition on the day of the operation.

"This translates to better care for the patient," Dr. Clifford Ko, director of the Division of Research and Optimal Patient Care at ACS told HCB News. "We know that changing culture is paramount to improving quality of care. We have multiple examples of hospitals participating in the American College of Surgeons Quality Programs that have improved their culture and then improved their surgical outcomes."

The project is funded and guided by the Agency for Healthcare and Research Quality (AHRC) — part of the U.S. Department of Health and Human Resources — and has led several high-profile, evidence-based health delivery initiatives aimed at reducing hospital-acquired infections and improving patient safety, among other things.

The ERAS project is seeking all types of hospitals — from rural to academic — to participate in the project. Initially the program will focus on abdominal operations in colorectal surgery but future phases will include bariatric, orthopedic, gynecology and emergency general surgery.

Rosen stressed that to be successful, participating hospitals will need to reinvent the way they deliver care.

"For long-term effects, each facility must transition from being a part of an enhanced recovery after surgery project, to incorporating enhanced recovery after surgery protocols into their new normal," he said. "If facilities can do this, they will be able to sustain any improved outcomes they realized. If they cannot create a new normal, they are likely to revert back to previous practices."

The pay-off, according to both Rosen and Ko, are significant. Benefits include: reducing patient length of stay in the hospital; reducing readmissions to the hospital after discharge; reducing preventable infections; reducing complications; and improving patients' satisfaction with their care.

The ACS will provide onsite ERAS leadership and technical assistance to help participating hospitals overcome barriers to change. Interested hospitals can learn more by emailing: enhancedrecovery@facs.org

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