tality rate hasn't changed since the 1970s and is the third-leading
cause of death in the world right now. Essentially, we're doing an
amazing job in the OR, but not such an amazing job for the 30 days
following surgery. Don't forget, too, that because of the "traditional"
approach, many patients have slid into opioid addiction, which is its
own enormous health crisis.
You need to explain this to every member of your care team. Aside
from the surgeons, they don't usually see patients again after surgery
and therefore don't know what's going on with them during the 30-day
post-op period.
Healthcare professionals ask me to send them ERAS protocols all
the time. I'm happy to, but I make one thing abundantly clear: The
likelihood ERAS will be adopted at their institution is very low unless
their medical staff takes ownership of the process and becomes truly
convinced they actually developed an effective enhanced recovery
protocol.
Engage your surgeons, nurses, anesthesiologists. Sit everyone down
and ask, "What are we going to do and how are we going to change
our current practices?" If you get buy-in, they'll change those prac-
tices. If you don't, they won't.
With ERAS, the most challenging factor isn't the technology or the
drugs or the costs, it's the human factor. It's getting people to under-
stand and agree that they need to change some of their practices. It's
really a sales job. If you succeed in selling enhanced recovery pro-
gram to patients and staff, like any other sale, you'll reap the benefits.
OSM
4 8 • 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
Dr. Kain (zeev.kain@yale.edu) is president of the American College of
Perioperative Medicine and a Chancellor's Professor of Anesthesiology and
Orthopedics at the University of California, Irvine.