Innovative Approach to Surgical Recovery Used at Swedish Medical Center, Now Adopted Across HCA Healthcare

Englewood, CO, 2 Jan 2023 — Swedish Medical Center’s parent organization HCA Healthcare recently announced the successful implementation of its Enhanced Surgical Recovery (ESR) program across more than 150 of its facilities. This patient-centered, research-based, multidisciplinary approach to has demonstrated significant improvements in surgical recovery, including a two-day average reduction in length of hospital stays and an up to 44% decrease in opioid usage for some surgeries. While Swedish has been using the program for over two years, the hospital’s success with the program has led to a wider implementation of the protocols.

“At Swedish, we have long been committed to addressing the opioid epidemic through innovative programming,” explains Jaya Kumar, MD, chief medical officer at Swedish Medical Center. “We began using ESR more than two years ago and have found it effective in reducing opioid usage while simultaneously improving surgical outcomes and patient satisfaction. We are excited that the program we have pioneered now is being adopted by sister facilities across the nation.”

ESR uses select pre-, intra-, and post-operative interventions to optimize outcomes and the patient experience. The program was derived from Enhanced Recovery after Surgery (ERAS), a recovery program that has been standard practice in Europe for a number of years and consists of up to 21 components. HCA Healthcare’s ESR focuses on the six tactics believed to have the greatest impact on patient outcomes:

  1. Goal-directed fluid therapy: active monitoring of a patient’s fluid balance to achieve an optimal hydration level throughout the surgery.
    2. Patient education: equipping patients with a personal recovery checklist so they can play an active role in their care.
    3. Multimodal pain management: an individualized approach only using opioids on an as-needed basis and instead using non-opioid pain relievers and other pain management techniques.
    4. Permissive pre-op hydration/carb loading: drinking fluids and a carbohydrate-rich drink before surgery to improve hydration and insulin resistance as well as to curb nausea.
    5. DREAM = drink, eating, and mobilization within 24 hours post-op: encouraging patients to drink, eat and move shortly after their surgery.
    6. Multidisciplinary team: creating a group of team members, including a surgeon champion, an anesthesia champion, nursing, and a pharmacy, who work together to guide the facility’s program and each patient’s care journey.

HCA Healthcare, the parent company of Swedish Medical Center, is a learning health system that uses data from approximately 35 million annual patient encounters to share best practices and focus on continuously improving care. Based on data collected from 141,482 joint replacement, gynecologic oncology, colorectal and bariatric surgeries in 2021, the ESR protocol has shown to be a proven roadmap to help improve surgical results, including:

  • A 2.1-day reduction in length of stay;
    • A 54% decrease in 30-day readmissions for joint replacements;
    • A 45% decrease in 90-day readmissions for gynecological surgery;
    • Up to a 44% decrease in opioid usage; and
    • 2.4 million fewer morphine medications dispensed.

Based on these outcomes delivered to its patients, HCA Healthcare invested an additional $20 million in monitoring equipment to support expanding the program to other surgical service lines in 2021.