Vancouver Coastal Health has created the following ERAS pathways since 2013:

• Colorectal surgery Radical Cystectomy
• Gastrectomy
• Gynecologic Oncology surgery
• Gynecologic surgery
  
• Hepatectomy
• Pancreatectomy
• Retroperitoneal Lymph Node Dissection
• Spine (Posterior Thoracic-Lumber) surgery 

Our lessons learned:

• 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
  

• 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