HCA Healthcare’s innovative approach to surgical recovery promotes better outcomes, decreased opioid usage and faster recovery times for patients

HCA Healthcare recently announced our enterprise-wide adopted Enhanced Surgical Recovery (ESR) program, a patient-centered, research-based, multidisciplinary approach to surgical recovery. The ESR program has been adopted by 167 HCA Healthcare facilities and has demonstrated significant improvements in surgical recovery, including a two-day average reduction in the length of hospital stays and an up to 44% decrease in opioid usage for some surgeries.

ESR uses select pre-, intra- and post-operative interventions designed to improve outcomes and the patient experience. The program was derived from Enhanced Recovery after Surgery (ERAS), a recovery program that has been standard practice in Europe for a number of years and consists of up to 21 components. HCA Healthcare’s ESR focuses on the six tactics believed to have the greatest impact on patient outcomes:

1. Goal-directed fluid therapy: active monitoring of a patient’s fluid balance to achieve an optimal hydration level throughout surgery.
2. Patient education: equipping patients with a personal recovery checklist so they can play an active role in their care.  
3. Multimodal pain management: an individualized approach only using opioids on an as-needed basis and instead using non-opioid pain relievers and other pain management techniques.
4. Permissive pre-op hydration/carb loading: drinking fluids and a carbohydrate-rich drink before surgery to improve hydration and insulin resistance as well as to curb nausea.
5. DREAM = drink, eating and mobilization within 24 hours post-op: encouraging patients to drink, eat and move shortly after their surgery.
6. Multidisciplinary team:  creating a group of team members, including a surgeon champion, an anesthesia champion, nursing and pharmacy, who work together to guide the facility’s program and each patient’s care journey.

Jared Stockett, a double knee replacement patient at HCA Healthcare’s West Valley Medical Center, is one of more than two million patients who have participated in the ESR program adopted by facilities throughout HCA Healthcare. “The surgeries went really well. Each time I went in at 8 a.m., the surgery started around 10 a.m. and I went home around 3 p.m. that afternoon. By the time I left the hospital, I had already been up and walking with a walker,” said Stockett. “Three days after each surgery, my knee already felt better. By following the instructions from my care team, recovery went very smoothly.”

As a learning health system, HCA Healthcare uses data from approximately 35 million annual patient encounters to share best practices and focus on continuously improving care. Based on data collected from 141,482 joint replacement, gynecologic oncology, colorectal and bariatric surgeries in 2021, the ESR protocol has shown to be a proven roadmap to help improve surgical results, including:

• A 2.1-day reduction in length of stay;
• A 54% decrease in 30-day readmissions for joint replacements;
• A 45% decrease in 90-day readmissions for gynecological surgery;
• Up to a 44% decrease in opioid usage; and
• 2.4 million fewer morphine medications dispensed.

Based on these outcomes delivered to patients, HCA Healthcare invested an additional $20 million in monitoring equipment to support expanding the program to other surgical service lines in 2021.

Related article: HCA Healthcare sets record by collecting 19,423 pounds of medication during fourth annual Crush the Crisis – HCA Healthcare Today