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What is Enhanced Recovery After Surgery?

Enhanced Recovery After Surgery - ERAS is a program highlighting surgical best practices. 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.

Enhanced Recovery Canada is leading the drive to improve surgical safety across the country. These six core ERAS principles have been endorsed to shift the surgical care paradigm:

  • Patient and family engagement
  • Nutrition management
  • Perioperative fluid and hydration management
  • Multi-modal opioid sparing analgesia
  • Perioperative best practices
  • Mobilization

Implementation of the ERAS principles involves a team consisting of patients, surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and healthcare team that cares for the patient before, during and after surgery. 

A number of sites of excellence have already embraced the 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, University of Toronto Best Practices in Surgery, and the Winnipeg Regional Health Authority.

Why is this work important?

The identification of emerging best practices in surgical care safety along with a plan to spread and implement best practices is one of the actions reflected in the Integrated Patient Safety Action Plan for Surgical Care Safety.

More than one million surgical procedures were performed annually in Canada between 2004 and 2013. Over half of patient safety incidents in Canada are attributable to surgical care (Baker et al 2004). Given the improved patient outcomes, ERAS has the potential to make a significant impact in surgical safety and surgical care outcomes. 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. 

Who is leading this work?

An inaugural Surgical Care Safety Best Practices Partners meeting was held in Calgary, in January 2017. 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). The meeting was funded by industry sponsors, 3M and Medtronic; representatives from both organizations were invited to attend the meeting and contribute to the discussions. Other organizations that have since joined the partnership include the Canadian Home Care Association and the College of Family Physicians Canada.

At the meeting, an interdisciplinary team was formed to foster the momentum needed to move this work forward. A governance structure is now in place, led by Enhanced Recovery Canada.

A Project Charter has been developed; next steps are for the development of a dissemination and implementation strategy to advance the evidence-informed principles of ERAS in Canada. Noting patient engagement as the foundational core of this strategy, support from federal, provincial and territorial leaders, and healthcare executives will be vital in the implementation of the ERAS principles. Additionally, to demonstrate improvement with the ERAS principles, data collection and measurement will also be an integral part of this work.