Enhanced Recovery After Spine Surgery (ERASS) - Reducing Inpatient Length of Stay After Lumbar Spinal Fusions
Care Process & Redesign
National Healthcare Group Quality Improvement
National Healthcare Group
24 December 2025
To reduce the inpatient length of stay for patients undergoing 1 or 2 level elective spinal fusion surgery from 8.9 days to. The intervention successfully reduced the length of stay and associated costs, demonstrating the effectiveness of the ERASS practices.
Year Submitted: 2025
Published Date: 24 December 2025
Tags: Care Process ＆ Redesign, Cost Saving, Workflow Redesign, Quality Improvement, Length Of Stay, Value Based Care, Productivity
About this Content
Aims
To reduce the inpatient length of stay for patients undergoing 1 or 2 level elective spinal fusion surgery from 8.9 days to 7 days over a 6-month period with a target of 90% of patients achieving this (57.8% of patients at baseline).
Background
The project is based on the Enhanced Recovery After Spine Surgery (ERASS) initiative, which aims to reduce inpatient length of stay after lumbar spinal fusions. The background includes the need for a multidisciplinary approach and improved communication among staff to achieve better outcomes.
Methods
The methodology involves implementing several Plan-Do-Study-Act (PDSA) cycles to address root causes of delayed discharge, such as standardizing analgesia protocols, implementing a standardized physio regime, and conducting pre-operative nurse clinician counseling clinics.
Results
The intervention led to a reduction in the average length of stay from 8.97 days to 5.38 days per patient, resulting in cost savings of $3,755.14 per patient. The percentage of patients achieving a post-operative length of stay of 7 days increased from 57.8% to 87.5%.
Conclusion
The intervention successfully reduced the length of stay and associated costs, demonstrating the effectiveness of the ERASS practices in improving patient outcomes for spinal fusion surgeries.
Lessons Learnt
Key lessons include the importance of a multidisciplinary approach, the need for consistent communication among staff, and the challenges of getting surgeons to agree to a standardized workflow.
Keywords
Spinal Fusion, Length of Stay, Cost Savings, Orthopaedics, Nursing
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | National Healthcare Group Quality Improvement |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Orthopaedics |
Project Lead(s) | Yap Ming Quan Wayne, Wang Dan |
Project Member(s) | Nishal Kishinchand Primalani |
Connect with this contributor!
Group Quality - nhggroup.QRM@nhghealth.com.sg