A paper published by Ko Awatea and the Ministry of Health in the New Zealand Medical Journal shows how 18 DHBs are implementing Enhanced Recovery after Surgery (ERAS) protocols in their orthopaedic services.
The paper, Implementation and effects of Enhanced Recovery After Surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services, by Suzanne Proudfoot and Brandon Bennett of Ko Awatea, and Simon Duff and Julie Palmer of the Ministry of Health, describes the implementation of ERAS for elective hip and knee joint replacement and acute fractured neck of femur, and its effects.
ERAS comprises an evidence-based, multimodal, patient-centred rehabilitation programme for patients undergoing surgery. It is known to significantly improve surgical outcomes for patients and the cost-effectiveness of care.
The National Orthopaedic ERAS Collaborative, launched in 2013, implemented ERAS protocols using IHI Breakthrough Series (BTS) collaborative quality improvement methodology.
Compliance with the elements that make up ERAS increased from 33% to 75% for knee replacements, from 31% to 78% for hip replacements, and from 29% to 51% for fractured neck of femur. The length of time patients spent in hospital for knee joint replacement fell from 5.4 days to 4.5 days, and for hip replacement from 5.1 days to 4.3 days.
“ERAS can be difficult to implement because it requires all members of a multidisciplinary peri-operative team to work together to implement identified protocols. The National Orthopaedic ERAS Collaborative shows that BTS methodology works to implement ERAS on a large scale,” says Suzanne Proudfoot, Projects and Campaign Manager, Ko Awatea.
“When you look at the success we’ve had with this and our Target CLAB Zero collaborative, which reduced the national CLAB rate in intensive care units by 96%, you can see the potential of this methodology to address other problems in healthcare.”