St. Mark's Hospital - November 01, 2017

The HCA Enhanced Surgical Recovery program is available to all surgical teams interested in using this multimodal evidence-based program focused on improving surgical outcomes.

What is It?

HCA’s ESR program consists of an abbreviated approach to the 21 surgical recovery elements comprising the Enhanced Recovery after Surgery (ERAS) program, which has been a standard practice in Europe for years.

These enhanced surgical recovery programs have demonstrated significant reductions in length of stay, blood loss, time to ambulation, and complications; as well as significant increases in patient satisfaction around pain. They are being used by 95% of surgery patients in the United Kingdom.

ESR addresses five key recovery domains: nutrition, fluid, pain, mobilization, and patient satisfaction. The ESR program suggests the implementation of key tactics from these domains in the preoperative, intraoperative, and postoperative periods.

What Clinical Tactics Are Used in ESR?

  • Preoperative
    • Malnutrition screen
    • Carbohydrate load
    • Fluid volume assessment
    • Multimodal analgesic optimization
  • Intraoperative
    • Goal-directed fluid optimization
    • Avoidance of tubes, drains, lines
    • Epidural / regional anesthesia
    • Nausea and vomiting prophylaxis
  • Postoperative
    • Early oral nutrition
    • Early mobilization
    • Fluid optimization
    • Multimodal analgesic optimization
    • Post-op nausea / vomiting treatment

How Can I Learn More?

ESR implementation materials are available on ATLAS, and ESR-experienced physician contacts are available through the Medical Staff Office. Specialty-specific implementation documentation is available for colorectal surgery, cardiovascular surgery, and total joint surgery. Additional documentation is also available relevant to pain management, goal-directed fluid therapy, and sepsis.

Am I Required to do this?v

No. ESR is a voluntary, evidence-based program offered by HCA to support surgical teams who desire to improve their surgical outcomes.

Because there is strong evidence of improved patient outcomes, all medical directors of surgical programs are encouraged to familiarize themselves with the ESR program elements relevant to their specialty and adapt the tactics to their own patient population.

What Players Do I Need to Get Started?

Typically, successfully implemented ESR programs have been initiated by at least one interested surgeon collaborating with at least one interested anesthesiologist. Please contact Tonya Terrell, Director of Surgical Services, with questions.


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