# Improving implementation of Enhanced Recovery After Surgery (ERAS) to increase timeliness of recovery after cardiac surgery: a quality improvement project

## TL;DR

This study shows that improving Enhanced Recovery After Surgery (ERAS) practices can speed up recovery after cardiac surgery and help reduce NHS surgery backlogs.

## Contribution

A phased educational intervention with time-directed ERAS goals significantly improved recovery timeliness in cardiac surgery.

## Key findings

- The proportion of patients ready for ward discharge within 24 hours increased by 15.6%.
- The proportion of patients ready for ward discharge within 48 hours increased by 18.0%.
- No increase in reintubation or ICU readmission rates was observed.

## Abstract

The COVID-19 pandemic has exacerbated the backlog of elective surgeries across the National Health Service (NHS). This is particularly critical for patients awaiting cardiac surgery, where even short delays can lead to disease progression and increased risk of complications. Enhanced Recovery After Surgery (ERAS) programmes aim to optimise recovery and reduce length of stay, yet their implementation in cardiac surgery remains inconsistent. This quality improvement project sought to improve the implementation of postoperative ERAS principles to increase the timeliness of recovery and enhance intensive care unit (ICU) capacity.

Time-directed ERAS goals were developed, and a phased educational intervention was implemented through four Plan–Do–Study–Act cycles: (1) introductory teaching and baseline data collection, (2) development of a tool within the electronic patient record to promote real-time implementation of ERAS goals and enable continuous performance monitoring, (3) introduction of an e-learning module and (4) targeted educational interventions. Outcome measures included time to achieve ERAS goals and the proportion of postoperative patients clinically ready for discharge to the ward within 24 and 48 hours. Balancing measures included reintubation and ICU readmission rates.

Implementation of the phased educational intervention led to a sustained reduction in the time required to achieve ERAS goals. The proportion of patients clinically ready for discharge to the ward within 24 and 48 hours increased by 15.6% and 18.0%, respectively, exceeding the project’s 5% target. No increase in reintubation or ICU readmission rates was observed, indicating that improvements were achieved safely.

Implementing time-directed ERAS goals through a phased educational intervention increased the timeliness of post-operative recovery after cardiac surgery. This approach has the potential to improve patient flow, enhance ICU capacity and support wider efforts to address elective cardiac surgery backlogs across the NHS.