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The most commonly employed technique for providing general anaesthesia uses a balanced approach, where different drugs are used to reach specific desired endpoints. The variety of drugs used can result in a dozen or more different compounds being administered during a 'routine anaesthetic' procedure. Drug interactions are quite common and their clinical effects can be very significant. Clinically, general anaesthesia has 4 goals. These are: unconsciousness/amnesia; analgesia; muscle relaxation and maintenance of homeostasis. The anaesthesiologist tries to select only those drugs that permit a rapid onset of desirable operative conditions so that surgery can be performed properly and rapidly. Such drugs should also minimally disturb the patient's preoperative homeostatic maintenance, and maximise return to a desirable postanaesthetic functional state.

BackgroundEnhanced recovery after surgery (ERAS) protocols have been shown to be effective at accelerating return to functioning, reducing length of stay, and reducing cost per encounter at major medical centers and health systems across the United States and Europe. Implementation in the community hospital setting has been considered more challenging due to a wide range of factors. This study demonstrates the successful creation of such a program in a community hospital in central North Carolina.MethodsStarting in the spring of 2016, an anesthesiology-led, multidisciplinary ERAS team was formed with the purpose of developing an enhanced recovery after major urologic surgery program. A clinical protocol was developed by the team that met quarterly to review metrics. Outcome data were collected by chart review and compared to pre-ERAS values in a retrospective, nonrandomized, consecutive fashion and underwent statistical analysis.ResultsOverall, a reduction in both average and median length of stay (37% reduction) was observed in the post-ERAS group along with a reduction in 90-day readmission. Statistical analysis confirmed a very strong likelihood (p<.0001) that the ERAS protocol resulted in the observed reduction in the length of stay.DiscussionThis study demonstrated the feasibility of starting an ERAS program in a community hospital as well as the critical role that anesthesiology leadership can provide. An anesthesiology-led ERAS program offers a solution to some of the challenges faced by community hospitals regarding variable and silo-based care. ERAS pathways aim to implement standardized and coordinated evidence-based care protocols through multidisciplinary teams representing the entirety of the surgical encounter, leading to more consistent and favorable outcomes for patients and hospitals. This model can be applied to many other services in addition to the major urology effort described here.