The healthcare industry's financial challenges have been exacerbated by the COVID-19 pandemic. Enhanced recovery after surgery protocols can help health systems reduce the length of stay, minimize post-surgical infections and decrease readmissions, which can provide much-needed financial relief.
During a webinar in November hosted by Becker's Hospital Review and sponsored by Cardinal Health, Keith Beiermeister, MD, general colon and rectal surgeon at Scripps Memorial Hospital La Jolla (Calif.), discussed current financial challenges and how ERAS protocols have made a difference in multiple service lines at Scripps. RosieMarie (Rosie) Squeo, RN, senior consultant at Cardinal Health, shared an example of a surgical kitting option adopted by Scripps as part of its ERAS program.
Four insights:
- The current healthcare system is financially unsustainable and must be changed. Healthcare spending in the United States surpassed $4 trillion in 2020, with more than 30 percent of spending on hospital services. Hospital costs averaged $2,607 per day and hospital-acquired infections cost $9.8 billion. "We need to start doing things that work and stop doing things that don't," Dr. Beiermeister said. "What we need — COVID or no COVID — is a system that reduces length of stay, reduces complications and reduces readmissions."
- ERAS is a proven multidisciplinary, evidence-based approach to decrease hospital stay, reduce costs and increase patient satisfaction. Developed more than two decades ago for colorectal surgery, ERAS is arguably an accelerated recovery program for all surgical patients. It begins with patient education during the presurgical evaluation and includes things like early removal of drains and tubes, rapid ambulation and prompt transition to pain medications in a post-operative setting. "All of this leads to increased patient satisfaction," Dr. Beiermeister said. "We're focused on decreasing perioperative complications and length of stay as well as improved use of hospital resources."
- Over time, multiple service lines at Scripps have increased ERAS participation with definite trends to shorter stays, fewer complications and decreased readmissions. For example, colorectal surgeries began using ERAS protocols in 2017 and have made significant and steady progress. "When we look at our baseline data, we have cut our hospital length of stay in half; that's a significant cost savings for the hospital," Dr. Beiermeister said. Scripps has incorporated ERAS protocols in gynecology, bariatric and its cardiac arrest program. "I think what we're beginning to see in our most recent efforts is a decrease in our ICU length of stay, which is going to have huge impacts on cost savings," he added.
- Multidisciplinary education, communication and cooperation are keys to change. One example at Scripps involved the implementation of an ERAS surgical kitting program. Originally, the colorectal surgeons' office was ordering and assembling all the components of a colorectal patient surgery kit. This was a cumbersome, time-consuming process for staff. When Cardinal Health offered to create a custom surgery kit, there was some concern that the sales representative was just selling a new product. "We had to educate the materials management team, the physician's office, clinicians and managers on the need for this ERAS kitting program as well as the benefits and cost savings it would provide for patients," Ms. Squeo said.
"These relatively simple, evidence-based practices can change our trajectory," Dr. Beiermeister said. "They have the added benefit of fostering interdisciplinary collaboration and culture, which is especially needed now when we're struggling with staffing issues. ERAS protocols can reduce cost and improve the value of surgical care for our patients."
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*Dr. Beiermeister is a paid consultant for Cardinal Health