Pre-admission Enhanced Recovery Program (ERP) Bundle

ERP Bundle Packets

Why the Bundle?

  • Growing evidence indicates ERP bundles can reduce complications such as surgical site infection, acute kidney injury, and cardiovascular injury.
  • A therapeutic dose of L-citrulline in each serving provides a safer increase in systemic arginine and reduction in asymmetric dimethyl arginine for nitric oxide function) while avoiding high acidity of other products.
  • The savings found more than justify the addition of ERP bundle to all surgery protocols.

Bundle Contents/Usage:

  • 15 servings of Forte protein support formula, taken 3 times per day for 5 days prior to surgery.
  • 3 servings of GED, taken day prior and twice on day of surgery


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ERPB (15 Forte/3 GED): $67.50 per box

Request ERP Bundle Information

Benefits to Patient:

  • Improved surgical outcome, shorter recovery
  • A low sugar and diabetic/hypoglycemic friendly formula
  • Pleasant taste, easy to mix and use
  • 20-25% discount to retail for bundle components for “out of pocket expenses
  • Easy delivery of entire bundle directly to their home
  • Eliminates the need to individually purchase bundle components
  • Single instruction sheet to guide bundle purchase by the patient
  • Single instruction sheet for patient education and bundle usage

Benefits to Surgeon:

  • Streamlined ordering: one order for the surgeon via the EMR versus multiple orders for antibiotics and gabapentin independently
  • Leverages staff time with no increase in practice expense
  • Educational instruction sheet reduces time taken to educate staff and patient
  • Educational instruction sheet reduces afterhours phone calls to surgeon and office
  • Educational instruction sheet provides documentation of encounter in EMR
  • Helps remove ERAS “failure” for pre-op patient compliance, thus reducing post-op complications and reducing LOS
  • Confirms patient has access to the key pre-admission ERP components in a single unit delivered to their home
  • Documentation of recommendation and order of bundle components for QI processes of quality of care

Key Components for Success:

  • Surgeon and staff advocate for the bundle & components as an important part of their care plan, whether they buy as a unit or separately.
  • Patient understands the benefits of ERP bundle, including discounted cost, ease of access and 24/7 educational support via web site.
  • System considers their options if the patient chooses not to buy the bundle or can not afford the purchase. Require ERP bundle as part of patient out of pocket expense or covered by system as part of overall cost reduction plan.
  • Patient understands that the surgeon needs them to comply with this part of the care plan. These components and proper usage are essential to optimize their chances for a good recovery.
  • If a patient cannot pay for the bundle, the facility could cover the cost to garner the post-op benefits, and/or offer a discount to all patients by underwriting a portion of the bundle cost.