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CPSI Share                                                                      

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

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

Tracey Hong

Contact Information

Tracey Hong
Quality and Patient Safety Coordinator