Title : Improving recovery at the bedside: A quality improvement approach to ERAS implementation in a high-acuity trauma surgery facility
Abstract:
Level I trauma centers care for patients with high acuity and physiologic complexity, placing them at increased risk for postoperative complications, prolonged length of stay (LOS), and hospital readmissions. Existing variations in postoperative practices across service lines limited consistency, interdisciplinary coordination, and recovery-focused care delivery. Evidence demonstrates that Enhanced Recovery After Surgery (ERAS) standards improve outcomes through reduced complications, shorter LOS, and fewer readmissions; however, implementation in trauma settings presents unique challenges. Establishing a standardized, trauma-adapted ERAS framework is critical to reducing unwarranted care variation, improving patient outcomes, optimizing hospital capacity, and aligning postoperative recovery with evidence-based quality and safety priorities.
Methods: This quality improvement initiative was conducted at a Level I Trauma Center and Level IV Maternal Care facility. A unified, ERAS standard was developed using evidence-based ERAS and service line specific guidelines and implemented across seven specialties: obstetrics, gynecology, colorectal, urology, cardiac, hip, and spine surgery. Standardized, time-based ERAS metrics were extracted from the electronic health record and integrated into a centralized database capturing preoperative, intraoperative, and postoperative phases of care. Implementation strategies included the creation of two dedicated ERAS Coordinator roles within the Quality Department, deployment of unit-based ERAS Champions, and delivery of multidisciplinary education through Ticket to Success events. Microlearning was reinforced through ERAS roadshows and targeted one-page tip sheets aligned with identified performance gaps. Program evaluation focused on ERAS compliance, staff engagement, and trends in postoperative complications, LOS, and readmissions.
Analysis: Analysis evaluated trends in ERAS compliance, multidisciplinary engagement, and process reliability following implementation. Longitudinal review of ERAS metrics assessed adherence to high-impact elements, including multimodal pain management, early nutrition, progressive mobility, and timely device removal. Comparative review by service line identified areas of strong performance and persistent variation, often related to workflow complexity or care transitions. Educational data demonstrated increased participation and ownership following unit-based education and ERAS Champion engagement. Qualitative feedback highlighted improved interdisciplinary communication and clearer role accountability, while remaining gaps most commonly involved transitions of care and competing clinical priorities. Overall, findings supported that a coordinated, trauma adapted ERAS framework strengthened recovery-focused care consistency within a high-acuity environment.
Results: Implementation of a standardized ERAS framework resulted in improved care standardization, staff engagement, and recovery-focused practice consistency across participating service lines. Integration of ERAS metrics into the electronic health record improved visibility of perioperative performance and supported real-time feedback. Educational initiatives were associated with increased awareness of ERAS principles and greater interdisciplinary participation. Many staff volunteered to serve as ERAS Champions, reflecting increased ownership and accountability at the unit level. Early process outcomes demonstrated improved adherence to key ERAS elements, including multimodal pain management, early mobility, nutrition advancement, and standardized discharge practices. Units with consistent ERAS Champion involvement showed reduced variation in postoperative care. Dedicated ERAS Coordinators supported sustained monitoring and rapid identification of opportunities for improvement despite ongoing operational challenges.
Conclusion: Implementing a ERAS framework in a Level I Trauma Center reduced unwarranted practice variation, strengthened interdisciplinary collaboration, and supported recovery-focused surgical care. This initiative demonstrates that sustained ERAS success requires organizational commitment, dedicated coordination, and continuous education. The approach provides a scalable model for improving postoperative outcomes and reliability of care in high-acuity trauma settings.
