HCB News: What kind of results have you achieved, and how long did it take you to see those? PC: We saw positive results with our very first patient. We decreased our length of stay from an industry average of 6 days down to 2 days with almost no narcotic usage, and we’re to the point where some colorectal patients are going home on postoperative day 1, having taken no narcotics (except for the surgery itself). Specifically, with properly performed preoperative ultrasound-guided TAP blocks using long acting bupivacaine and a mixture of non-opioid medications that are given around the clock, not PRN, most patients receive two thirds less narcotic than they would have otherwise, and many patients go home never having taken a narcotic while in the hospital.
We’ve also seen drastic reductions in our colorectal infection rate, down to as low as 2% over a 2-year period.
HCB News: What would you estimate your ROI to be on your program? PC: CMS estimates that the average SSI costs a facility $28,000. Becker’s CFO report estimates that an average hospital stay is $2,400 per day. Over the course of our program since 2015, I estimate our ROI to be over $2 million. Perhaps just as important, for the patients who have expressed an opinion, their satisfaction has definitely increased.
HCB News: What role and what importance does ultrasound play within ERAS protocols? PC: Properly placed TAP blocks, placed preoperatively with point-of-care ultrasound guidance by anesthesia, are a core component of our opioid sparing ERAS protocols. When TAP blocks are done by surgeons intraoperatively, the effect is diminished because the nervous system and brain have already registered the pain.
HCB News: What advice would you give to a hospital hoping to implement an ERAS program and what can they expect to achieve? PC: The rallying cry for the Connecticut Surgical Quality Collaborative (CtSQC.org) is: "We are building a Cathedral”. Implementing an ERAS program is similar in that it takes a truly multidisciplinary team, a clear focus on what the end product should look like, and the constant ability and drive to re-measure and re-adjust as often as necessary.
Essential to this program is the need for unity and alignment at all levels, including administrative support. Saint Mary's is always striving to improve patient care and the patient experience. We are very lucky to have an administration that lives in breathes and believes this every day. At the same time, we are a midsize, tightly aligned facility that allows us to take advantage of the nimbleness of a smaller facility as well as the patient impact of a larger facility. I think we have proven that with the right mindset and team, both large and small institutions can easily build impactful protocols.
