HCA Healthcare Inc. has rolled out an Enhanced Surgical Recovery (ESR) program enterprise-wide. What the company calls a "patient-centered, research-based, multidisciplinary approach to surgical recovery" has been adopted by 167 HCA Healthcare facilities.
Nashville-based HCA, which has 182 hospitals and approximately 2,300 ambulatory sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics, in 20 states and the United Kingdom, said the program has demonstrated significant improvements in surgical recovery, including a two-day average reduction in length of hospital stays and an up to 44 percent decrease in opioid usage for some surgeries.
“After studying more than 20 years of clinical research and peer-reviewed publications in addition to our own internal data, we discovered that a facility making a few key changes, such as using multimodal approaches to managing pain and encouraging patients to eat and walk around within 24 hours after surgery, can have a significant impact on a patient’s recovery,” said Randy Fagin, M.D., chief medical officer of HCA Healthcare’s National Group, in a statement. “From the physician’s office prior to surgery to follow-up care, a facility’s ESR program allows patients to play an active role in managing their own care and recovery plan.”
ESR uses select pre-, intra- and post-operative interventions designed to improve outcomes and the patient experience. The program was derived from Enhanced Recovery after Surgery (ERAS), a recovery program that has been standard practice in Europe for a number of years and consists of up to 21 components. HCA Healthcare’s ESR focuses on the six tactics believed to have the greatest impact on patient outcomes:
- Goal-directed fluid therapy: active monitoring of a patient’s fluid balance to achieve an optimal hydration level throughout surgery.
- Patient education: equipping patients with a personal recovery checklist so they can play an active role in their care.
- Multimodal pain management: an individualized approach only using opioids on an as-needed basis and instead using non-opioid pain relievers and other pain management techniques.
- Permissive pre-op hydration/carb loading: drinking fluids and a carbohydrate-rich drink before surgery to improve hydration and insulin resistance as well as to curb nausea.
- DREAM = drink, eating and mobilization within 24 hours post-op: encouraging patients to drink, eat and move shortly after their surgery.
- Multidisciplinary team: creating a group of team members, including a surgeon champion, an anesthesia champion, nursing and pharmacy, who work together to guide the facility’s program and each patient’s care journey.
HCA said that as a learning health system, it uses data from approximately 35 million annual patient encounters to share best practices and focus on continuously improving care. Based on data collected from 141,482 joint replacement, gynecologic oncology, colorectal and bariatric surgeries in 2021, the ESR protocol has shown to be a proven roadmap to help improve surgical results, including:
• A 2.1-day reduction in length of stay;
• A 54 percent decrease in 30-day readmissions for joint replacements;
• A 45 percent decrease in 90-day readmissions for gynecological surgery;
• Up to a 44 percent decrease in opioid usage; and
• 2.4 million fewer morphine medications dispensed.
Based on these outcomes delivered to patients, HCA Healthcare invested an additional $20 million in monitoring equipment to support expanding the program to other surgical service lines in 2021.