Scaling an Enhanced Recovery Program to an Institution-Wide Initiative: It Takes a Village

Abstract

Background and Objective: With the inclusion of Enhanced Recovery Programs (ERPs) into routine clinical practice, scaling programs across an institution is important to drive sustainable change in a patient-centric care delivery paradigm. A review of ERP implementation within a large institution was performed to understand key components that hinder or facilitate success of scaling an ERP. Methods: From January 2018 to March 2018, a needs assessment was completed to review implementation of enhanced recovery across the institution. Implementation progress was categorized into one of 5 phases including Define, Implement, Measure, Analyze, and Optimize. Results: Only 25% of service line ERPs reached the optimization phase within 5 years. One hundred percent of respondents reported more strengths (n = 41) and opportunities (n = 41) than weaknesses or threats (n = 25 and 14, respectively). Commonly identified strengths included established enhanced recovery pathways, functional team databases, and effective provider education. Weaknesses identified were inconsistencies in data quality/collection and a lack of key personnel participation including buy-in and time availability. Respondents perceived the need for data standardization to be an opportunity, while personnel factors were viewed as key threats. Conclusion: Identification of strengths, weaknesses, opportunities, and threats could prove beneficial in helping scale an ERP across an institution. Successful optimization and expansion of ERPs require robust data management for continuous quality improvement efforts among clinicians, administrators, executives, and patients.

Development and implementation of an institutional enhanced recovery program data process

“…The ERP Universe enabled an 85% decrease in data abstraction time, which allowed departmental personnel to be reallocated from data sourcing and management activities to other duties and tasks. Personnel costs often present a significant barrier to enhanced recovery implementation and sustainability (Stone et al, 2016; Kruse et al, 2020). The ERP Universe can help overcome this restriction by diminishing personnel resource needs.…”

“…Few studies have demonstrated the benefits of a single universe that can not only support research efforts but also facilitate internal benchmarking, quality improvement, institutional reporting, and clinical operations and decision-making. In one internal analysis, Kruse et al found that a lack of data collection resources, standard processes, and reporting mechanisms limited data management in an ERP and recommended that improvements be made with minimal operational disruptions and costs (Kruse et al, 2020). The findings of the present study show that the single ERP Universe allows institutional ownership of the data to support not one service but an entire program.…”