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Archive Anesthesia 2020

Send Patients Home Sooner and Healthier

Enhanced recovery protocols are more important than ever during the coronavirus crisis.

Zeev Kain, MD, MBA


BE PREPARED Successful implementation of enhanced recovery protocols involves more intensive patient education and communication throughout the entire episode of care.

COVID-19 has completely changed the calculus of outpatient surgery. You want patients to spend as little time in your facility as possible — and likely, so do they. You must be more proactive than ever in advancing high-value, high-quality care pathways. The Enhanced Recovery After Surgery (ERAS) and the Perioperative Surgical Home (PSH) models can be extremely powerful, transformative tools in that effort.

I've seen enhanced recovery work wonders for patients and facilities alike, time and time again. Effective implementation requires both evidence-based standardization and highly individualized patient care. It's a lot of work to implement. There are lots of hearts and minds to win over, and time-honored practices to change. But it's worth it in the end.

Golden opportunity

Let's consider this unique moment in time. The importance and power of ERAS is greater than ever — especially in outpatient environments. The long-running shift of surgeries of increasing complexity from inpatient to outpatient ORs undoubtedly will accelerate, thanks in no small part to the perception among many patients and perioperative professionals that an outpatient environment is safer from a COVID-19 perspective.

Perhaps you view enhanced recovery and the surgical home as more appropriate for inpatient cases, but it's just as appropriate in outpatient settings. I was first in the U.S. to start an inpatient PSH model, which is a similar model to ERAS just, in my view, a bit more comprehensive. We started with orthopedic inpatients, then moved into outpatient facilities, where we added patients undergoing cholecystectomies to those undergoing ortho procedures.

We showed that enhanced recovery methodologies significantly reduced the time patients spent in ambulatory facilities — by hours, for the cholecystectomy patients — improved patient experience scores, and lowered both pain scores and incidences of PONV (

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