The Challenge
The Department for Abdominal Surgical Oncology at the Institute of Oncology Ljubljana had been working to implement Enhanced Recovery After Surgery (ERAS®) protocols since 2006, caring for approximately 200 colorectal cancer patients each year. Despite their commitment, the team struggled to achieve consistent, measurable compliance due to the absence of a structured implementation framework and effective auditing tools. This hindered their ability to drive lasting improvements across perioperative care processes and to deliver optimal patient outcomes, as compliance levels remained below the threshold needed for sustained impact.
The Solution
The department, under the clinical leadership of Dr. Erik Brecelj and Dr. Rok Petrič, entered the ERAS® Implementation Program (EIP), supported by Encare and the ERAS® Interactive Audit System (EIAS). With systematic audit capabilities in place, the team could identify specific compliance gaps and build a clear improvement plan around the data. The program included development of educational materials for staff and patients, internal multidisciplinary presentations, and the application of a plan-do-study-act model for each process change. The team successfully navigated a mid-program transition to the updated colorectal protocol, with guidance from Prof. Dr. Olle Ljungqvist of the ERAS® Society throughout.
The Results
The results of structured ERAS® implementation through the EIP and EIAS were clear. Within eight months, the department achieved ERAS® Qualification, with measurable improvements across every key metric: average length of stay reduced from 11.7 to 6.3 days, complication rates decreased from 78.4% to 18.2%, ICU admissions dropped from 41.2% to 9.1%, and readmissions fell from 4% to 0%. ERAS® compliance reached 79%, up from 46.8%. The team established a multidisciplinary framework for continuous audit and staff education, and are already planning a national ERAS® symposium on 1 October to extend that knowledge across Slovenia.
