[AVBC 2025] The ERASS Framework - Reducing Inpatient Length of Stay & Improving Outcomes After Spine Surgery
Care Process & Redesign
Workforce Transformation
Appropriate & Value-based Care Conference
National Healthcare Group
5 December 2025
We embarked on a multidisciplinary Clinical Improvement project to develop and implement ERASS (Enhanced Recovery after. A multidisciplinary team executing our ERASS protocols works effectively to reduce inpatient length of stay and improve patient.
Year Submitted: 2025
Published Date: 05 December 2025
Tags: Care Process ＆ Redesign, Workforce Transformation, Quality Improvement, Workflow Redesign, Productivity, Cost Saving, Clinical Practice Improvement, Value Based Care, Length Of Stay, Patient Reported Outcome Measures, Job Redesign, Multi-Disciplinary
About this Content
Aims
We embarked on a multidisciplinary Clinical Improvement project to develop and implement ERASS (Enhanced Recovery after Spine Surgery) protocols with the aim to reduce the inpatient length of stay for patients undergoing 1 or 2 level elective spinal fusion surgery to 7 days, with a target of 90% of patients achieving this.
Background
MOH Value Driven Outcomes (VDO) data from 2014 to 2022 showed our clinical quality index for Spinal Fusion Surgery in TTSH at 45.1%, with a high average length of stay (aLOS) of 8.9 days compared to a national average of 6.1 days. Only 60.3% of TTSH patients achieve 7 days aLOS. International Enhanced Recovery after Spine Surgery (ERASS) guidelines have demonstrated improved patient outcomes and this has not been adopted in our local setting yet.
Methods
In the diagnostic phase, we identified 5 main root causes affecting a patient's length of stay, pertaining to the domains of (i) Anaesthesiology/Pain relief, (ii) Physiotherapy and (iii) Nursing. To tackle (i), we developed a multimodal analgesia package and Local Anaesthetic Cocktail to optimise perioperative pain control. For (ii), we worked with our physiotherapy colleagues to implement a novel post op ambulation protocol for early ambulation. For (iii), we set up a Pre-Op Nurse led counselling clinic for patient education and early identification of any post operative care barriers.
Results
Over a 6-month period with interventions introduced in stepwise fashion, we saw our aLOS drop from a pre intervention mean of 8.97 days to 5.38 days. 87.5% of spinal patients achieved aLOS 7 days from a baseline of 57.8%. There were also improvements in VDO outcome scores in the areas of 30-day no blood transfusion rate (93.4%), 30-day no return to OT rate (94.7%) and 30-day no readmission rate (100%). Our program yielded an annualized cost savings of $223,944.
Conclusion
A multidisciplinary team executing our ERASS protocols works effectively to reduce inpatient length of stay and improve patient clinical outcomes. Important parameters to guide our ERASS framework include perioperative pain control, early ambulation, and patient education.
Lessons Learnt
The implementation of ERASS protocols requires a multidisciplinary approach and highlights the importance of perioperative pain control, early ambulation, and patient education in improving clinical outcomes.
Keywords
ERASS, Spine Surgery, Length of Stay, Patient Outcomes, Cost Savings
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Surgery |
Project Lead(s) | Yap Ming Quan Wayne |
Project Member(s) | Yap Ming Quan Wayne |
Connect with this contributor!
Yap Ming Quan Wayne - wayne.mq.yap@nhghealth.com.sg