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In this 69-minute webinar, anaesthesiologist Dr Thomas Boogmans and pharmacist and clinical biologist Laura Bogaert from AZ Rivierenland in Belgium show how ERAS® can be successfully implemented in hip and knee arthroplasty. It is aimed at orthopaedic surgeons, anaesthesiologists, nurses, physiotherapists, quality managers and hospital leaders who are starting or improving an ERAS® pathway in orthopaedics. You will learn which care elements matter most, how AZ Rivierenland translated the ERAS® guidelines into a local protocol, and how change management turns a protocol into daily practice.
Dr Boogmans opens with the hospital's own results, monitored in the ERAS® Interactive Audit System (EIAS): a mean length of stay of 1.7 days after hip arthroplasty and 1.8 days after knee arthroplasty, and a complication rate of around 8–10% that deliberately includes postoperative pain. He then moves from Henrik Kehlet's 1997 paper to the ERAS® Society guideline for hip and knee arthroplasty published by Thomas Wainwright in 2020, with its 17 recommendations. His key message is that there is no consensus on which elements matter most, but that a core set – multimodal opioid-sparing analgesia, timely tranexamic acid and early mobilisation – appears consistently, and that higher compliance with a local protocol leads to better outcomes, as shown in the POWER2 study. He walks through the protocol at AZ Rivierenland: joint classes and an ERAS® nurse for patient education, diabetes screening, prehabilitation and nutrition, carbohydrate loading, patient blood management (up to 25% of patients are anaemic before surgery), surgery without a tourniquet, high-dose corticosteroids, intravenous tranexamic acid, mobilisation within 24 hours and nurse-led discharge criteria. Laura Bogaert then explains why ERAS® adoption varies so widely and how to lead the change: the individual change curve, adopter categories, Kotter's eight-step model, quick wins and monitoring. The session closes with the hospital's timeline from a kick-off email in 2018, via an Excel file and a free online database, to the ERAS® Implementation Program, EIAS and ERAS® Qualification in September 2023, followed by ten commandments for implementation and a Q&A on iron therapy, patient blood management, the ERAS® nurse, 90-day complications and how long to monitor a pathway.
Speakers
- Dr Thomas Boogmans
Anaesthesiologist and Medical Head of the Surgical Day Hospital (campus Bornem), AZ Rivierenland, Belgium – presents the ERAS® principles in hip and knee arthroplasty, the hospital's protocol and its implementation journey. - Laura Bogaert
Pharmacist and Clinical Biologist, Laboratory of Clinical Biology, AZ Rivierenland, Belgium – presents the practical implementation of ERAS® and change management. - Charlotte Zwart
Customer Success Manager, Encare – host and moderator.
Chapters
- 00:00 Welcome and introduction
- 01:32 Opening and audience poll
- 03:01 Goals of the session
- 03:41 Results at AZ Rivierenland
- 05:55 What is ERAS® to you?
- 07:12 The theory: from Kehlet to the ERAS® Society guideline
- 10:27 What you need to know: core elements and compliance
- 13:19 The local protocol and preoperative patient education
- 14:57 Optimisation of chronic disease
- 16:17 Prehabilitation, nutrition and carbohydrate loading
- 19:33 Patient blood management
- 21:15 Intraoperative care: surgical approach and anaesthesia
- 23:35 Multimodal opioid-sparing analgesia
- 25:20 Fluid therapy and high-dose corticosteroids
- 27:16 Tranexamic acid, normothermia and PONV prophylaxis
- 28:21 Early mobilisation and discharge criteria
- 30:23 Thromboprophylaxis
- 31:53 ERAS® adoption rates worldwide
- 34:11 Change as an emotional journey and adopter categories
- 36:41 Quality improvement and change management frameworks
- 38:21 Kotter's eight-step change model
- 41:08 Removing obstacles to change
- 43:47 Quick wins, sustaining and embedding the change
- 46:08 The implementation timeline at AZ Rivierenland
- 48:38 Take-home messages
- 49:21 Ten commandments for ERAS® implementation
- 52:53 Q&A: the geriatrician in the ERAS® team
- 54:10 Q&A: treating preoperative anaemia with iron
- 57:16 Q&A: getting surgeons to use patient blood management
- 1:00:08 Q&A: the role of the ERAS® nurse
- 1:01:24 Q&A: in-hospital and 90-day complications
- 1:02:12 Q&A: removing barriers to preoperative optimisation
- 1:07:01 Q&A: how long to monitor an ERAS® pathway
- 1:08:45 Closing remarks
Related resources
- ERAS® Interactive Audit System (EIAS) – Encare's audit system for ERAS® compliance and outcomes
- ERAS® Implementation Program (EIP) – the structured implementation programme
- ERAS® hip & knee arthroplasty protocol
- ERAS® Qualification and the map of ERAS® Qualified Centers
- ERAS® Society – guidelines and the ERAS® programme
- ERAS® Society consensus statement for total hip and total knee replacement (Wainwright et al., Acta Orthopaedica 2020)
- 'Enhanced recovery after surgery': tijd voor de standaard in chirurgie? – article by Boogmans, Bogaert et al. (in Dutch)
- AZ Rivierenland
Want to see how EIAS can support ERAS® implementation and audit in hip and knee arthroplasty at your hospital? Book a demo