Table 3 Implementation Model for ERAS Protocol Barriers

Patient’s travel distance to hospital

Build “hub and spoke” model hospital network

Surgery performed at larger hospital but patients are seen closer to home for pre- and post-operative visits

Poor patient health literacy

Design communicable pre- and post-operative counseling (pamphlets and posters created, in lay terms) and offer easy access for communication via telephone or internet

Trusted relationships develop between patients and providers

Relatively low-volume surgical practice

Use evidence-based changes in practice

Improved outcomes yield change of culture

Care staff education challenges in the face of workforce shortages and high turnover

Streamline processes, standardized order sets, educate staff about the benefits of ERAS

Measurable goals are transparent for all. Intrinsic motivation of caregivers that ERAS is best for patients. Reduce total patient-days on wards.

Few financial resources for equipment and medication, higher percent Medicare and Medicaid patients, lower reimbursement

Implement accelerated post-operative track with safe discharge. Prioritize stock of ERAS components, multimodal analgesia and justify to payers and administrators

Cost-containment through lower LOS, complications and readmission