Cardiac Enhanced Recovery After Surgery: A Guide to Team Building and Successful Implementation

Enhanced Recovery After Surgery (ERAS) is a bundled approach to perioperative care based upon the philosophy that patients do better when emotional and physiologic stresses are minimized during surgery. The goal of ERAS is to return patients to normal functional status as quickly as possible. Initially designed for patients having colorectal surgery, ERAS programs have now been developed for nearly every surgical subspecialty. Multiple studies examining the effect of ERAS have demonstrated decreased postoperative complications, length of stay, costs, and increased patient and staff satisfaction. Interest in the application of ERAS to cardiac surgery has grown significantly over the last few years. Several core principles transcend all ERAS cardiac programs. Implementation of cardiac ERAS is more than simply the installation of a protocol. ERAS involves a methodical shift in culture, meeting the challenges of initiating and sustaining meaningful organizational change, and pivoting to a patient-centered system of care to optimize speed and completeness of recovery. Herein we detail the crucial team building, education, planning, and processes needed to develop and sustain a successful ERAS cardiac program.