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3/8/2017 5:00 PM

This article is the first in a series on Enhanced Recovery After Surgery. As the national strategy evolves, information for the public, providers and leaders will be posted to www.SHIFTtoSafety.com. Click on the link to learn more and watch for upcoming articles!

Enhanced Recovery After Surgery (ERAS) consists of a number of evidence -based principles that support better outcomes for surgical patients including: an improved patient experience, reduced length of stay, decreased complication rates and fewer hospital readmissions.

 "We want to take the ERAS learnings and evidence that has been acquired internationally and within Canada, and develop a strategy that can be moved across the country," says Carla Williams Patient Safety Improvement Lead, Canadian Patient Safety Institute.

To start the ball rolling, a face-to-face meeting with key stakeholders was made possible through the generous support from 3M and Medatronics.

"3M organizes its perioperative business around surgical best practices and has developed a number products and solutions for enhanced surgical care," says Lisa Mackie, Business Manager- Infection Prevention Division at 3M Health Care. "Developing an ERAS strategy involves many healthcare disciplines and collaboration across all the groups, and including industry is the key to success. This is a first step and it was a privilege to be involved."

"The synergy and level of engagement of our partners at the meeting was amazing," says Carla Williams.  "You could feel the passion, energy and commitment in the room. It would have been difficult to foster the rich conversations we had at the table and build the same momentum virtually. And, we could not have accomplished what we did without our industry sponsors."

The inaugural S3A-Surgical Care Safety Best Practices Partners meeting, held in Calgary, Alberta, on January 29, 2016, has created a burning platform for the development of a dissemination and implementation strategy to advance the evidence-informed principles of ERAS in Canada.

Some 24 organizations were invited to attend the face-to-face meeting, including representatives from Patients for Patient Safety Canada, the Royal College of Physician and Surgeons of Canada, Canada Health Infoway, various surgical specialties (Canadian Association of General Surgeons, Society of Obstetricians and Gynecologists Canada, Canadian Anesthesiologists' Society), provincial quality councils and allied health organizations (Dieticians of Canada, Canadian Physiotherapy Association, and Canadian Society of Hospital Pharmacists). Representatives from both 3M and Medatronics were also invited to attend the meeting and contribute to the discussions.

"In addition to patient engagement, the ERAS principles also involve pain management, mobility and enhanced nutrition guidelines so we wanted to ensure the contribution of all relevant stakeholders," says Carla Williams. "The value of all of our partners working together is essential to achieving great outcomes with ERAS."

A number of sites of excellence have already embraced ERAS principles, including: Alberta Health Services (AHS), British Columbia Patient Safety & Quality Council and the Doctors of British Columbia, Eastern Health, McGill University Health Centre, and University of Toronto Best Practices in Surgery.  During the meeting, AHS, McGill and the University of Toronto shared their learnings.

Based on input from the meeting, a project charter has been developed to incorporate seven ERAS principles in all surgical care:

  • Patient engagement and awareness of the ERAS principles.
  • Nutrition guidelines (pre and –post-op) that include: no NPO (fasting at midnight), carb-loading pre-op, and feeding on post-op day zero.
  • Intra-operative fluid management.
  • Pain management and opioid sparing.
  • Minimization of nausea and ileus.
  • Minimization of tubes and drains.
  • Early post-operative mobility.

It was also agreed that data collection and measurement would be an integral part of this work. 

"The discussions during the meeting were very powerful," says Lisa Mackie. "Dr. Claude LaFlamme and Carla Williams did a fantastic job in setting up the day and leading the group discussions to scope out a plan to take this initiative forward."

The identification of emerging best practices in surgical care safety along with a plan to spread and implement these best practices is one of the actions reflected in the Integrated Patient Safety Action Plan for Surgical Care Safety.  Given the improved patient outcomes, ERAS principles emerged quickly as the logical choice. ERAS was originally developed exclusively for colorectal surgeries, however, the learning and evidence indicate that the same principles can be applied to any type of surgery. 

For more information on ERAS initiative, contact Carla Williams: cwilliams@cpsi-icsp.ca