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The Canadian Medical Association Journal (CMAJ) reports that enhanced recovery after surgery (ERAS) is changing the entire culture around surgery in terms of what is normally expected and what should be expected. For example, the ERAS® guidelines encourage stopping solid food for up to  eight hours and clear fluids two hours before surgery, which challenges historical surgical practices (nothing by mouth from midnight before the morning of surgery). The guidelines also promote early mobilization, having patients up and moving as soon as possible after surgery.

ERAS is an evidence-based approach to surgical care aimed at minimizing the stress of surgery and supporting patients to recover quickly. This evidence-based and multidisciplinary perioperative care pathway has been shown to promote patient mobilization, reduce complication rates after surgery, decrease hospital stay and reduce costs. 

The ERAS approach begins with the primary care physician before admission for surgery and continues throughout the intraoperative and post-operative phases of the surgical procedure. The primary care physician and nurse practitioners support the successful implementation of enhanced recovery and help to improve patient outcomes by offering preoperative education and counselling, such as helping the patient to cease smoking and alcohol intake four weeks ahead of surgery. A multi-disciplinary team of healthcare professionals coordinates the intra-operative and post-operative approach to ensure the successful implementation of ERAS protocols. This results in clearer communications channels, patients being engaged from diagnosis to recovery, healthcare practitioners applying care in a collaborative and supportive environment, and minimizing the discrepancy between best practice and clinical practice.

A patient engagement campaign is being launched by Enhanced Recovery Canada to highlight the importance of patients' participation to reduce the risk of complications after surgery. Patients will be encouraged to ask their clinicians if ERAS tools are being used for their surgical procedure. A tip sheet has also been created to increase patient participation that includes these three tips:

1. Ask questions and optimize your health: 

Play a part in surgical planning.  Ask questions about bowel preparation, the possibility of less intrusive surgery, and a plan for pain management minimizing opioids. Minimize alcohol consumption and stop smoking prior to surgery.

2. Eat and drink:

Drink water and sports drinks up to two hours and eat up to eight hours before surgery. Drink and eat soon after surgery.

3. Move:

Stay active before surgery and move as soon as you can after surgery.

Enhanced Recovery Canada (ERC) is a program of the Canadian Patient Safety Institute that is based on ERAS. With support from 24 Canadian partner organizations, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and helping to disseminate the ERAS principles. A number of Canadian surgical care teams within the following organizations have been early adopters of these evidence-based pathways. These include:  Alberta Health Services, Eastern Health in Newfoundland and Labrador, McGill University Health Centre, the University of Toronto's Best Practices in Surgery supporting various sites in Ontario, and some healthcare organizations in British Columbia.

The first ERC clinical pathway supports colorectal surgeries, with six core pillars that are known to improve care: patient and family engagement, nutrition, early mobilization, hydration, pain and symptom control, and surgical best practices. Pathways for other surgery types will follow. 

Last week, the Canadian Patient Safety Institute launched a Safety Improvement Project focused on ERC surgical best practices to support healthcare organizations implementing a program to advance enhanced recovery.  Seven teams from healthcare organizations across the country are participating in the 18-month knowledge translation/quality improvement learning collaborative.  The teams include representatives from:  Northumberland Hills (Cobourg, ON), Réseau de Santé Vitalité Health Network (Moncton, NB), Brandon Health Center - Prairie Mountain Health Region (Brandon, MB), Victoria Hospital - Saskatchewan Health Authority (Prince Albert, SK), St. Martha's Regional Hospital - Nova Scotia Health Authority (Antigonish, NS), Integrated Health and Social Services Centre/Intègre de santé et de services sociaux (CISSS) de Chaudière-Appalaches (QC), and the Integrated University Health and Social Services / Centre Intègre universitaire de santé et de services sociaux  (CIUSSS) Centre-Sud-de-l'Ile-de-Montreal  - Notre-Dame  Hospital (Montréal, QC).

ERC has developed a number of resources for both patients and providers to support the enhanced recovery of colorectal surgery patients, that are made freely available on the Canadian Patient Safety Institute's website.

ABOUT CANADIAN PATIENT SAFETY INSTITUTE

The Canadian Patient Safety Institute (CPSI) is a not-for-profit organization that exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety. CPSI reflects the desire to close the gap between the healthcare we have and the healthcare we deserve. CPSI would like to acknowledge funding support from Health Canada. The views expressed here do not necessarily represent the views of Health Canada. www.patientsafetyinstitute.ca

ABOUT ENHANCED RECOVERY AFTER SURGERY

Enhanced recovery after Surgery (ERAS) is a multi-modal approach to recovery that was pioneered in 1995 by Danish colorectal surgeon Dr. Henrik Kehlet. The ERAS® Society (www.erassociety.org), is an international, multidisciplinary, not-for profit organization comprised of surgeons, anesthesiologists, nurses and allied health professionals who deliver the ERAS program. The ERAS principles have expanded around the world; they are now applied to nine different specialties.

ABOUT ENHANCED RECOVERY CANADA

Enhanced Recovery Canada (ERC) brings patients, healthcare providers and health systems together and creates tools and resources that are based on the most up-to-date evidence and helps to move this evidence into best practices. Currently, more than 40 healthcare professionals including surgeons, anesthesiologists, nurses, physiotherapists and dietitians from 10 provinces and two territories across various healthcare disciplines are invested in ERC. Members develop pathways, identify evaluation metrics and develop knowledge tools.

MEDIA CONTACT

For media enquiries and interview requests, contact:

Christopher Thrall, Communications Officer
Canadian Patient Safety Institute
Phone 780.566.8375
cthrall@cpsi-icsp.ca

External Resources
Hospitals helping patients recover faster from surgery
Enhanced recovery after surgery: implementing a new standard of surgical care
CMAJ Podcasts: https://soundcloud.com/cmajpodcasts/180635-view