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I am a Quality and Patient Safety Coordinator for Vancouver Coastal Health. I completed a bachelor degree in critical care nursing, and graduated from the Quality Academy program at British Columbia Patient Safety and Quality Council.

ERAS pathways we have created to date:

  • Colorectal surgery Radical Cystectomy
  • Gynecologic Oncology surgery
  • Hepatectomy
  • Pancreatectomy

My lessons learned since our first ERAS implementation in 2013:

  • Involve key stakeholders at planning phase to facilitate commitment, engagement and ownership. We also have a core team, an Operation Director, who has authority and power to make changes, an anesthesiologist and surgeon champions, an ERAS coordinator plus champions from every peri-operative care areas
  • Have a clear and robust definition of the ERAS components and outcomes measures
  • Standardize and develop documentation to incorporate ERAS elements and milestones, such as patient education booklet to empower and engage patient prior to admission, pre-printed order sets to ensure ERAS elements are being ordered and followed, clinical pathway (with highlights daily ERAS milestones) to use as a guidance for the frontline staff and as a tool so that data are readily available for auditing
  • Conduct real time audit on process measures and PDSA cycles, so that we are able to modify the process in a timely manner and enhance the improvement
  • Be available and visible to provide just-in-time teaching and connect with the frontline team on an ongoing basis, especially vital at the early phase of implementation   
  • Share results (process and outcomes) with teams on a regular basis, such as every 3-4 months for all peri-operative care teams and every month with the Steering Committee. This is to foster engagement and seek feedback from teams
  • Our results illustrate that:
  • attention to details and small multiple changes, aggregation of marginal gains can result in dramatic improvements in patient outcomes
  • adoption of ERAS pathway has resulted in a significant decrease in complication
  • increased adherence was associated with a greater reduction in complications
  • Celebrate quick win
  • Reinforce ERAS principles over and over
  • It takes time to change culture, so tenacity is vital!

Contact Information

Tracey Hong
Quality and Patient Safety Coordinator
Tracey.Hong@vch.ca