Structured Implementation of a Fast-Track Program - How Does it Work?

Fast-track or ERAS programs can give clinically relevant benefits for patients undergoing surgery. They also have financial advantages for the hospital. Despite these facts, fast-track has been implemented in only very few hospitals in Germany. Neither scientific evidence nor reimbursement regulations explain this lack of fast-track acceptance. It seems however that a structured process of change from traditional perioperative medicine to evidence based fast-track therapy is missing in Germany. In other countries, structured programs for fast-track or ERAS implementation have been successful in many hospitals. This article describes structured fast-track implementation divided into three consecutive steps: organisational preparation, clinical implementation and continuous examination of fast-track adherence, functional recovery, morbidity and postoperative length of hospital stay. Due to its complex nature, fast-track implementation should be guided by external fast-track experts.