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What is ERAS (Enhanced Recovery after Surgery) and how is it supporting better patient outcomes?

August 27, 2019
Dr. Philip Corvo
Healthcare Business News interviewed Dr. Philip Corvo, who has since 2013 served as chairman of the Stanley J. Dudrick Department Surgery and Director of Surgical Critical Care at Saint Mary's Hospital, Trinity Health Of New England.

He leads an innovative ERAS (Enhanced Recovery after Surgery) program which is helping reduce opioid use, speeding patient recovery and reducing costs. Under Corvo’s leadership, they have accomplished this through a combination of multidisciplinary approach and the use of technology like ultrasound guided TAP blocks.

HCB News: How did you first learn about ERAS [Enhanced Recovery after Surgery] protocols?
Dr. Philip Corvo: I first learned about enhanced recovery at my previous institution, Stamford Hospital, while working with the Chairwoman of Anesthesia Dr. Teresa Bowling. Dr. Bowling learned how to apply local regional blocks that our anesthesia colleagues were using on orthopedic patients to abdominal surgeries, and we became successful in decreasing pain and narcotic use in many of our general surgery patients. I then learned more about ERAS at an American College of Surgeons Quality and Safety conference. In my role as Chairman of Surgery, I am always striving to improve our patient safety and satisfaction and programmatic efficiency, and knew that I needed creative thinking to decrease our infection rates and opioid usage

HCB News: What are those objectives exactly?
PC: To increase patient safety by decreasing infections and opioid use; and to enhance patient safety, satisfaction and financial impact on the hospital by decreasing the patient’s length of stay.

HCB News: Were there any start-up costs associated with your ERAS program? Did you encounter any obstacles?
PC: There were no additional start-up costs. We did, however, need to purchase opioid alternative medications that we were not using before, and that posed a bit of a challenge for our pharmacy. Most hospitals still function in silos, and our pharmacy silo needed to appreciate the bigger picture, above and beyond their budgetary constraints. Better integration of pharmacy and their chain of command allowed us to overcome this obstacle.

In terms of costs, once the volume of patients increased above a critical point, we also needed to purchase more ultrasound machines for our TAP blocks.

HCB News: Who are the key stakeholders in the program and what surgical specialties are included?
PC: We currently have programs for colorectal, neuro spine, bariatrics, and OB/GYN. Properly performed ERAS programs are truly multidisciplinary. Patients, physicians, nurses, assistants, pharmacy, administration are all key stake holders. The team taking care of the patient at 2 am is just as impactful as the OR team was during the day. And we can’t forget that the most important stakeholder is the patient. Patient involvement, starting in the preop phase, is paramount, as is their understanding of the process. If a protocol describes getting a patient out of bed the night of surgery or removing a Foley catheter the night of surgery, the patient really does need to comply with this even if they are not in the mood at the time.

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