How Providence Anesthesiology Associates' ERAS program transitioned to the ASC setting

In 2016, Charlotte, N.C.-based Novant Health partnered with Charlotte-based Providence Anesthesiology Associates to implement and Enhanced Recovery After Surgery program at Charlotte-based Novant Health Presbyterian Medical Center.

Initially launched for colorectal surgery, the ERAS program has expanded to several other facilities and now includes bariatrics, gynecologic, oncology, urologic, hepatobiliary and thoracic surgical procedures.

The ERAS program has made a significant impact on thousands of patients, with reductions in length of stay, complication rates, readmission rates and perioperative opioid consumption. With many minimally invasive gynecologic surgical patients ready for discharge well under 24 hours, Novant Health and PAA extended the gynecology ERAS concepts into the ASC.

"Our vision for same day hysterectomies in an ASC is to offer the women in our community easier access, a smooth recovery without a hospital admission and a lower-cost option," said Novant Health Vice President of Surgical and Anesthesia Services Leslie Barrett. "Our outpatient surgical experience begins with the foundational commitment to safety and quality. Layered on top of this foundation is a coordinated, innovative, multidisciplinary team of experts, committed to the patient experience.”

Same day hysterectomies in the ASC harness the power of standardized processes, key patient selection criteria, utilization of only the highest performing surgeons and high-quality one-on-one patient education.
The outpatient venue provides an environment of significantly reduced procedure cost. The standardized instrumentation facilitates maximize opportunity for the healthcare system to streamline surgical expenses. Coupled with lower upfront cost, improved patient outcomes, reduced readmission rates and decreased postoperative convalescence, Novant Health and PAA deliver a model of care that rises to the challenge of reducing the healthcare cost spend in every facet.

In the last several years, there has been considerable focus on using Triple Aim to optimize healthcare system performance through improving the health of populations, improving the patient experience and reducing the cost of care. Recently, the focus on provider burnout has led to the expansion of the Triple Aim to the Quadruple Aim, expanding the areas of focus to also include improving the work life balance of the healthcare team.

The innovative model of the Novant Health Same Day Hysterectomy Center provides a venue to deliver on all four key tenets of the Quadruple Aim. The utilization of procedures with standard instrumentation and high performing surgeons allows the entire team to decrease the stress level in the perioperative environment. This simplification inherently not only improves the patient outcomes, but also the satisfaction of the providers. In addition, the same day hysterectomy center processes facilitate on-time starts and shorter turnover times that improve the daily life of the entire healthcare team.

“At our center, we have harvested the momentum of our practice’s burgeoning ERAS initiatives to afford our patients an outpatient solution for their procedures," said PAA Physician and Charlotte-based Center City Outpatient Surgery Medical Director Dan Briggs, MD. "The result has been universally positive in terms of patient satisfaction, surgeon buy-in and a reduction in opioid consumption.”

Novant Health Women's System Service Line Leader Navin Bhojwani, MD, said, “For the patients, less is more: they are out of commission for less time, they spend less for high quality care and they need and utilize less narcotics.”

Given the success of the outpatient hysterectomy program, Novant Health and PAA will continue to expand the outpatient ERAS program and transition other appropriate surgical procedures into the ASC setting.

Note: This has been edited for style and clarity.

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