At Virginia Commonwealth University (VCU) Health System in Richmond, implementation of Enhanced Recovery After Surgery (ERAS) incorporates principles of Lean thinking, a management methodology that emphasizes “…maximize[ing] customer value while minimizing waste. Simply, lean means creating more value for customers with fewer resources,” according to the Lean Enterprise Institute.1 Several…

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Enhanced Recovery After Surgery The implementation of Enhanced Recovery After Surgery (ERAS) is based on the concept of organizing care around the patient, addressing medical condition needs to optimize readiness for surgery and reducing the likelihood of postoperative complications. Efficacy is measured by how well we perform according to these…

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Editor's Note Though patient and personnel factors affect the order of case induction, induction time is most dependent on patient factors, this study finds. Of 15,823 cases analyzed, predictors of later patient induction included add-on case, ASA class 3 or more, neuraxial anesthesia, and CRNA staffing. In 11,093 (70.1%) cases,…

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Editor's Note Care coordination strategies were found to be associated with high overall hospital quality star ratings from the Centers for Medicare & Medicaid Services (CMS) in this study. A total of 710 general acute care noncritical access hospitals that received star ratings and responded to the 2015 American Hospital…

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At Virginia Commonwealth University System (VCU Health) in Richmond, we are using quality standards to establish operational definitions for elements of Enhanced Recovery After Surgery (ERAS). This article describes what those standards are and how they are implemented. Previous articles in this series appeared in the October 2019 and November…

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Editor's Note An Enhanced Recovery Pathway (ERP) created by the Mayo Clinic’s colorectal surgery service a decade ago has now been adopted by other surgical services in seven medical centers that are members of the Mayo Clinic Care Network, the October 15 Harvard Business Review reports. The ability of each…

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Our series on Enhanced Recovery After Surgery (ERAS), which began last month with an overview of its history and perioperative pathway, continues in this issue with examples of improved outcomes and the roles played by perioperative team members (see p 18). ERAS, known to speed recovery and increase patient satisfaction,…

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The US has been on a journey for the last several years to reduce the cost of healthcare. In 2017, the percent of gross domestic product attributed to healthcare goods and services was at 17.9%. This is expected to reach as much as 19.4% by the year 2027.1 Factors contributing…

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Editor's Note In this study, heart failure with or without symptoms was associated with an increased risk of postoperative mortality at 90-days and complications at 30-days in ambulatory surgery patients. In this analysis of 355,121 patients having noncardiac ambulatory surgical procedures, 90-day mortality was 2% in patients with heart failure…

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Enhanced Recovery After Surgery (ERAS®) is a comprehensive, multifaceted, and multidisciplinary approach to the care of the surgical patient. ERAS bundles evidence-based elements to facilitate a faster recovery with fewer complications.1 Spanning the continuum of perioperative care, ERAS elements include: • patient engagement and education • preoperative optimization of nutrition…

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