Implementing ERAS: How We Achieved Success Within an Anesthesia Department

Dan B. Ellis; Aalok Agarwala; Elena Cavallo; Pam Linov; Michael K. Hidrue; Marcela G. del Carmen; Rachel Sisodia


BMC Anesthesiol. 2021;21(36) 

In This Article


ERAS pathways can be implemented and sustained in large anesthesia practices. Most of the effort to successfully implement the pathway occurs in the planning/early implementation period. Obtaining buy-in from surgeons, anesthesiologists, and nurses is key. Therefore, we recommend assembling a multidisciplinary team to examine the latest evidence before creating the pathway, and we advise hosting small format meetings with impacted stakeholders prior to launching a pathway.

Once the pathway is designed, senior leadership support is necessary. This support can occur via large-format grand rounds. After this public display of support, emailing the entire pathway and evidence supporting the pathway to all providers who will be involved in the care of this type of surgical patient is useful. This approach, when supplemented with individual emails to providers on the night before the procedures, is effective. Also, providing individual feedback on compliance with the pathway is impactful. After a certain amount of time, in our case 14 months, sending continual reminders may not be necessary. However, we do recommend posting the pathway in a central repository as a reference for providers.

As our ERAS pathways mature, we will incorporate additional reporting structures for practitioners in addition to integrating complication data into our reports. We also plan to refine various elements of the pathway as evidence-based practices improve. This will keep our providers engaged and make sure we provide the highest-quality care to our patients.