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A Guide to Implementing Enhanced Recovery After Surgery Protocols: Creating, Scaling, and Managing a Perioperative Consult Service.

The practice of Medicine in the 21st century is a complex endeavor. With over 70,000 International Classification of Diseases-10 diagnosis codes, 10,000 current procedural terminology (CPT) procedural codes, and 1000 medications in the Physician’s Desk Reference, there is simply too much information for any physician to master completely. Even with specialization, the growth of new information continually redefines current practice. Each year, over 10,000 new randomized clinical trials are added to MEDLINE. One author has estimated that it would take reading 20 articles every day all year round for a practicing internist just to maintain present knowledge. Thus, it is no wonder that the delivery of medical care is frequently so far behind the development of new information. It is estimated that on an average it takes 17 years before 14% of the original research begins to effect patient care and another 9 years before it is adopted as standard clinical practice. Even once an intervention is considered standard of care, routine compliance can be as low as 30% to 40%. The significant variation seen among care of surgical patients is therefore not surprising.