How ERAS® can help reduce the COVID-19 backlog
The global pandemic interrupted daily healthcare around the world. Surgeries were some of the first appointments to halt as operating rooms began to double as intensive care units for the patients needing ventilatory support for COVID-19 pulmonary failure. This change in everyday practice has led to a fast-growing surgical backlog. ERAS® can help healthcare professionals implement the best standard of care across hospitals and clinics of all sizes to improve outcomes for surgical patients, enhance recovery after surgery to minimize the use of hospital resources and save cost.
An ERAS® pathway covers many care elements throughout the perioperative journey (pre-admission, preoperative, intraoperative, postoperative, discharge, and follow-up care). According to the recently published RECOvER Checklist (K Elias et.al, 2019), these elements must then be related to an audit system for pathway compliance.
One such auditing system is the ERAS® Interactive Audit System (EIAS) provided by Encare®. This is a web-based data entry and analysis system for surgical teams to take advantage of the benefits of the ERAS® Protocol and can be used to facilitate implementation and monitor compliance to the ERAS® Protocols. With an audit system, ERAS® teams can understand their adherence to an ERAS® protocol, receive immediate feedback regarding any deviation from best practice, and analyze the clinical outcomes in real-time.
By continuous follow-up, analysis, adjustments, and improvements, the perioperative team and its management will not only ensure improved quality of care for the patient but also improve the motivation of the staff involved in the preoperative care process. The ERAS® Interactive Audit System (EIAS) becomes a crucial support in the daily decision-making process and an important quality assurance tool.
Applying ERAS® Protocols will reduce complications and save costs.
Elective Surgery Standstill
The primary problem faced by healthcare providers during and in the aftermath of COVID-19 is the backlog following the near-complete standstill of elective surgeries. Secondly, on top of the cases known to be waiting for surgery, COVID-19 also associated with fewer patients seeking care suggesting a hidden and unknown number of patients re-appearing later than normal, many of them with more advanced disease.
Another problem with the elective surgery standstill is the lack of training young surgeons have received. Their typical training process has been largely interrupted by the pandemic combined with the relative death of surgical patients
The increased number and complexity of the case mix of patients on the horizon leads to yet another problem: capacity. Patients with more severe healthcare needs require more ICU and regular hospital care. The pressure that this need places upon hospital processes is not one that can be underestimated as it impacts both practical, daily operations as well as broader budgetary concerns. The longer patients stay, the higher the cost of care.
The optimal care process in most major surgeries involves 18 to 25 elements that must be supported to ensure the best possible patient outcome. The issue is that, while they might seem similar on the surface, each hospital operates differently. There is no standard of care that extends across organizations. Even within the same department, doctors and other caregivers manages their patients differently. This creates a huge variability in the care that is delivered to patients across the entire industry.
Because of the variability, an average hospital in any country has much room for improvement. ERAS® gives healthcare professionals the chance to create a more standardized delivery of care that can streamline operations across the medical field.
The Solution: ERAS®
Because it provides the opportunity to standardize care ERAS® is an invaluable tool in the post-pandemic backlog. The ability to present simple, definitive processes for physicians, nurses and all allied health care professionals, and patients alike helps address procedural issues that will speed up recovery and shorten a hospital stay. Preoperative preparation such as nutritional statements impact hospital stays. Drinking a carbohydrate beverage tailored for preoperative use within two hours of surgery, for example, could significantly shorten the in-hospital recovery process.
Reducing complications and the subsequent need for intensive care and prolonged hospital stay by providing as many patients as possible with quality care is a significant source of cost savings. Always important, saving as much money as possible without impacting quality of care is even more critical today. Surgeries are a major revenue stream for many hospitals, and the slowdown in cases paired with the increased bed use can strain an organization’s budget.
The Opportunity for Change
One thing almost universally recognized is the speed with which COVID-19 forced change. It can often take 15 or 20 years to make changes that benefit patients, but the pandemic ensured that the necessary modifications happened immediately. This was unprecedented in the healthcare industry.
To date, the ERAS® method of delivering care has achieved significant benefit. In the next phase of ERAS®, high-quality research produced rapidly and at low cost is needed to take surgery and anesthesia to the next level. During this time of global crisis, clinicians who provide perioperative care must unite and make the changes that will bring further enhancements for patients and health systems.
This is an opportunity to reinvent the entire patient experience while optimizing care standards and procedures to help increase cost savings. ERAS® makes it easy to keep track of patients and streamline their treatment to not only give them the best, most positive outcome possible, but also to improve the efficiency of those treating them.
COVID-19 has presented the opportunity for transformative change as the healthcare industry braces for the future. ERAS® makes that evolution simple for patients and care providers alike.
Courtesy by Olle Ljungqvist, Professor of Surgery & Chairman of ERAS® Society