Department-Wide Implementation of an Enhanced Recovery Pathway

Abstract

There is abundant data supporting the clinical effectiveness of enhanced recovery pathways (ERP). By combining multiple evidence-based interventions into a single multidisciplinary care package involving all perioperative phases, ERPs shorten hospitalization and reduce complications. In essence, ERPs represent a knowledge translation strategy to help get evidence into practice. Yet these pathways are complex, as they may contain up to 20 different perioperative elements, many of which are contrary to traditional surgical practice. Recent surveys of perioperative management practices for bowel resection in the USA reported that management remained fairly “conventional” for a large proportion of procedures, as the majority of cases in those studies still underwent bowel preparation and less than half received preoperative patient education. Like any significant change in practice, creating a culture of “enhanced recovery” requires vision, commitment, energy, planning, and (ideally) institutional support. Consensus must be achieved between all of involved care providers, and personnel must also be trained. A dedicated multidisciplinary team is ideal to synthesize the existing evidence into a practical and usable care pathway, as well as implement the pathway and perform continuous quality improvement. Substantial dedication is required from the multidisciplinary team members and a learning curve should be expected.