Implementation of an Enhanced Recovery After Surgery Protocol for Orthopedic Total Joint Arthroplasties

Background or Problem/Issue: Surgical and anesthesia staff developed an enhanced recovery after surgery (ERAS) pathway at David Grant Medical Center (DGMC), but there was no implementation strategy in place. The uptake of ERAS into healthcare institutions remained slow and inconsistent due to the complexity of implementing numerous interventions among many providers and across hospital services. Clinical Question or Purpose: For total knee arthroplasties (TKAs) and total hip arthroplasties (THAs) at DGMC (P), does implementing a standardized ERAS order-set (I) compare to standard order-set (C) change order-set usage (O)? Project Design: The design was a process improvement project that measured the utilization of a standardized ERAS order-set for TKAs and THAs in DGMCV orthopedic surgery department. Analysis of the Results: The standard ERAS order-set and implementation had no impact on practice change or patient outcomes at DGMC. The loss of the lead orthopedic stakeholder influenced provider resistance to not utilize a standardized ERAS order-set for TKAs and THAs during a four-week implementation period. Organizational Impact/Implications for Practice: This ERAS order-set creation and implementation had no impact on practice change at DGMC. However, site-specific barriers have been identified, and recommendations have been made for overcoming these barriers to aid in successful implementation of future ERAS order-sets.