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Shorter Recovery Time

Enhanced Surgical Recovery (ESR) is a patient-centered, research-based, multidisciplinary approach that uses selected preoperative, intraoperative and postoperative interventions to optimize outcomes and the patient experience. HCA Healthcare’s scale and unprecedented access to data have enabled us to share best practices while continuously refining and improving our ESR program.

HCA Healthcare’s ESR program focuses on a simplified approach, utilizing five tactics shown to have the greatest impact on improving patient outcomes:

  • Goal directed fluid therapy
  • Patient education
  • Multimodal pain management
  • Permissive preoperative hydration/carb loading
  • DREAM (drinking, eating and mobilization) within 24 hours post operation

HCA Healthcare’s Enhanced Surgical Recovery program has significantly reduced length of stay (LOS), blood loss, time to ambulation and complications, all while increasing patient satisfaction.


HCA Healthcare’s simplified, data-centric initiative has helped drive superior outcomes for patients, clinicians and hospitals. Our use of multimodal evidence-based treatments allows us to reduce and control the patient’s surgical pain, while also greatly reducing the need for the use of strong pain medications. More specifically, in 2019 we achieved:

  • An up to 3.6-day reduction in length of stay
  • A 28.8% decrease in 30-day readmissions
  • A 26.7% decrease in 90-day readmissions
  • A 50% decrease in opioid usage by patients
  • 1.57 million fewer morphine medications dispensed

The ESR program has proved effective in both improving health outcomes and bettering the patient experience. From the physician’s office prior to surgery through the patient’s follow-up care journey, HCA Healthcare’s ESR program has allowed our patients to play an active role in managing their own care plan.