Improving quality by introducing enhanced recovery after surgery in a gynaecological department: consequences for...

Enhanced Recovery After Surgery (ERAS) is a perioperative treatment protocol that can improve individual recovery. This allows patients to leave hospital earlier, implying a cost reduction. The programme seems to spread slowly. ERAS was introduced at the Department of Obstetrics and Gynaecology at Akershus University Hospital in 2005. The objective of this study was to monitor changes in the workload and work environment of the ward nursing staff when ERAS was introduced at the department.

A pre-postintervention prospective design was used. Triangulated data were collected immediately before introduction (Phase 1), soon after (Phase 2), and 1 year after introduction (Phase 3). Data sources in all phases were registrations of time spent caring for individual patients during their stay, personnel survey responses and verbal interviews with informants from different staff groups. Patients were included consecutively, the aim being to include a minimum of 40 per phase.

Time registration showed that during the observation period, there was a 28% reduction in mean length of stay (-1.3 days, 95% CI -1.63 to -0.97, p<0.001) and 39% reduction in total time used in nursing activities per stay (-162 min, 95% CI -239.3 to -84.4, p<0.001). The personnel survey had a 100% response rate and presented few changes other than decreasing workload. The interview data from four informants described a successful change.

The findings confirmed the successful introduction of ERAS in the gynaecological department of a large university hospital. The experiences we made indicate that the expected gains of implementing ERAS are achieved without compromising the workload or work environment of ward nursing staff.