Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery Michael C Grant, MD, Andrew Hanna, MD, Andrew Benson, CRNA, Deborah Hobson, BSN, Christopher L Wu, MD, Christina T Yuan, PhD, Michael Rosen, PhD, Elizabeth C Wick, MD, FACS BACKGROUND: Our aim was to determine whether the establishment of a dedicated operating room team leads to improved process measure compliance and clinical outcomes in an Enhanced Recovery after Surgery (ERAS) program. Enhanced Recovery after Surgery programs involve the application of bundled best practices to improve the value of perioperative care. Successful implementation and sustainment of ERAS programs has been linked to compliance with protocol elements. STUDY DESIGN: Development of dedicated teams of anesthesia providers was a component of ERAS imple- mentation. Intraoperative provider team networks (surgeons, anesthesiologists, and certified registered nurse anesthetists) were developed for all cases before and after implementation of colorectal ERAS. Four measures of centrality were analyzed in each network based on case assignments, and these measures were correlated with both rates of process measure compliance and clinical outcomes. RESULTS: Enhanced Recovery after Surgery provider teams led to a decrease in the closeness of anesthe- siologists (p ¼ 0.04) and significant increase in the clustering coefficient of certified registered nurse anesthetists (p ¼ 0.005) compared with the pre-ERAS network. There was no sig- nificant change in centrality among surgeons (p ¼ NS for all measures). Enhanced Recovery after Surgery designation among anesthesiologists and nurse anesthetistsdwhereby individual providers received an in-service on protocol elements and received compliance data was strongly associated with high compliance (>0.6 of measures; p < 0.001 for each group). In addition, high compliance was associated with a significant reduction in length of stay (p < 0.01), surgical site infection (p < 0.002), and morbidity (p < 0.009). CONCLUSIONS: Dedicated operating room teams led to increased centrality among anesthesia providers, which in turn not only increased compliance, but also improved several clinical outcomes. (J Am Coll Surg 2018;226:267e276. Ó 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.) Patients undergoing operations often see numerous pro- viders across a number of perioperative patient care envi- ronments. This leads to substantial variation and even introduces the potential for disparate levels of patient care. During the past several years, surgeons have begun to address variability in perioperative management through the creation of Enhanced Recovery after Surgery (ERAS) programs. Enhanced Recovery after Surgery has sparked excitement in the surgical community both domestically and abroad due to its ability to lessen the impact of surgical insults and hasten patient recovery, as adoption of ERAS programs has been associated with a reduction in rates of surgical complications, CME questions for this article available at http://jacscme.facs.org Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. Drs Grant and Hanna contributed equally to this work. Presented at the American College of Surgeons 102 nd Annual Clinical Congress, Washington, DC, October 2016. Received November 6, 2017; Revised December 1, 2017; Accepted December 1, 2017. From the Departments of Anesthesiology and Critical Care Medicine (Grant, Benson, Wu, Yuan, Rosen) and Surgery (Hobson), the Johns Hop- kins Medical Institutions, Baltimore, MD, Department of Surgery, Univer- sity of Pennsylvania, Philadelphia, PA (Hanna), and Department of Surgery, University of California, San Francisco, CA (Wick). Correspondence address: Elizabeth C Wick, MD, FACS, Department of Surgery, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143-2205. email: Elizabeth.Wick@ucsf.edu 267 ª 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jamcollsurg.2017.12.010 ISSN 1072-7515/17