the end.
Golden opportunity
Let's consider this unique moment in time. The importance and
power of ERAS is greater than ever — especially in outpatient envi-
ronments. The long-running shift of surgeries of increasing complex-
ity from inpatient to outpatient ORs undoubtedly will accelerate,
thanks in no small part to the perception among many patients and
perioperative professionals that an outpatient environment is safer
from a COVID-19 perspective.
Perhaps you view enhanced recovery and the surgical home as
more appropriate for inpatient cases, but it's just as appropriate in
outpatient settings. I was first in the U.S. to start an inpatient PSH
model, which is a similar model to ERAS just, in my view, a bit
more comprehensive. We started with orthopedic inpatients, then
moved into outpatient facilities, where we added patients undergo-
ing cholecystectomies to those undergoing ortho procedures.
We showed that enhanced recovery methodologies significantly
reduced the time patients spent in ambulatory facilities — by hours,
for the cholecystectomy patients — improved patient experience
scores, and lowered both pain scores and incidences of PONV
(osmag.net/kVA5Hp).
However, the ultimate goals of ERAS are different for your outpa-
tient facilities than they are for an inpatient hospital stay. In the out-
patient environment, you need to focus on improving:
• time to discharge (length of stay still applies, but here it's about how
long the patient stays in PACU);
• patient experience scores (highly important in the outpatient envi-
ronment); and
• 30-day revisits to the ER for reasons like pain and PONV.
4 4 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 2 0
