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Dawning of new ERAS for surgery patients

December 10, 2013

Faster recoveries, fewer complications thanks to AHS innovations

Story by Tara Grindle; Photo by Kerry Williamson

For Joan Poplawski, recovering from surgery last spring was much smoother than she expected thanks to a new Alberta Health Services (AHS) initiative.

The Enhanced Recovery After Surgery (ERAS) project standardizes care before, during and after surgery, in an effort to get patients back on their feet sooner while shortening hospital stays and reducing complications after surgery.

Drawing from best practices around the world, the project improves protocols related to nutrition, mobility after surgery, and anesthetics and pain control.Surgery patient Joan Poplawski meets Dr. Micheal Chatenay, the lead surgeon working on the Enhanced Recovery After Surgery (ERAS) project at the Grey Nuns Community Hospital in Edmonton. ERAS, developed by AHS’ Strategic Clinical Networks, is helping surgery patients recover sooner and with fewer complications.

Poplawski was one of the first patients to benefit from the protocols when she had colorectal surgery at the Grey Nuns Community Hospital in Edmonton.

“Everything went very, very smoothly,” says Poplawski.

“The pre-op education by both the surgeon and nurse was unbelievably helpful. They spent time with my husband and I, and we knew exactly what to expect.”

During her two days in hospital, Poplawski ate regular meals after surgery and got moving again quickly.

“I wanted to leave the hospital as soon as possible and get back home,” she says.

“I was able to do that with no trouble after the surgery. Within 10 days, I was out for a five-kilometre bike ride.”

ERAS is one of nine approved Strategic Clinical Network (SCN) projects currently underway.

Worldwide, ERAS protocols have reduced complications after colorectal surgery by up to half, and have decreased hospital stays by a third.

“The program is based on great research and what works best for recovery,” says Dr. Gregg Nelson, co-chair of the ERAS steering committee. “Most important, it involves the patient and family in understanding and taking part in their care to promote recovery.”

Dr. Nelson likens surgery recovery to the mental and physical challenges of running a marathon.

“Marathon runners make sure they are in the best shape possible before a race. They load up on carbohydrates to give their bodies the energy they need. When they hit the finish line, they don’t sit down – they keep moving and quickly replenish the nutrients and fluids they used,” he says.

“ERAS protocols are based on many of these same principles. We help patients improve their strength leading up to surgery, and keep them strong throughout by reducing fasting times and encouraging carb loading. Following surgery, patients are up moving as soon as possible, which might involve adjustments to their medications so they can physically move and eat sooner.”

ERAS training has since been completed with all staff working in colorectal surgery at the Grey Nuns Community Hospital and the Peter Lougheed Centre in Calgary, the two pilot sites which will become ‘centres of excellence’ for colorectal surgery.

Baseline data was collected over the summer and the ERAS protocols were implemented for use with all patients beginning in September.

Dr. Cliff Sample, Facility Chief, Surgery, Grey Nuns, says his colleagues are excited that their hospital is a pilot site for the ERAS program.

“Since the mid 2000s, our facility has been moving toward earlier feeding, decreased narcotic use, and early mobilization of post-operative patients,” says Dr. Sample. “I have long been a supporter of ERAS protocols and I am very pleased to see the progress that the implementation team has made.”

ERAS protocols have been developed by the international ERAS Society and are currently used for colorectal patients at 25 health care facilities in 17 countries, including the McGill University Health Centre in Montreal, Kelowna General Hospital and 12 academic hospitals in Ontario.

The ERAS project is led by the AHS’ Obesity, Diabetes and Nutrition SCN and is supported by the Surgery SCN. Learnings from the two pilot sites will be shared provincewide to expand ERAS to other sites and surgical areas.

“The ERAS project is exactly the kind of work SCNs were created to do,” says Tracy Wasylak, AHS Vice-President, SCNs. ”This is a shift for staff but it is based on strong research and putting the patient first.”
Wasylak says ERAS and the other SCN projects are an exciting step forward in improving care.

“We are working to make a more efficient system that produces better outcomes for our patients. SCNs are how AHS is making these changes happen,” she says.

SCNs are provincewide teams of patients and families, health care professionals, researchers, community leaders and policy-makers. Each network is working to reshape health care and enhance the patient journey, improve outcomes and standardize care across the province.