What is ERASAlberta?
In Alberta, ERAS is being implemented at most major acute care hospitals under a priority provincial initiative called ERASAlberta sponsored by the Surgery Strategic Clinical Network (SCN)TM. ERASAlberta brings physicians and clinical teams together to implement select ERAS international guidelines at local sites. Clinical practice changes and quality improvements at ERAS sites are supported by provincial coordination of
- clinical knowledge translation
- clinical data collection
- provincial and site performance reports
- patient and provider education
- integrated research projects
- knowledge exchange
- quality management and evaluation
Who is involved in ERASAlberta?
Each ERAS site team is led by a surgeon, an anesthesiologist, and an operations leader along with a dedicated ERAS Nurse Coordinator experienced in clinical engagement, clinical data and quality improvement. The ERAS Site teams are connected through the ERASAlberta provincial coordination team. The ERASAlberta work is lead and guided by a provincial implementation lead, an integrated research lead, and medicine and surgeon co-leads. The Surgery SCNTM provides ERASAlberta with access to executive leadership, advanced clinical data analysis, research opportunities, and knowledge translation and implementation expertise.
How does ERAS work in Alberta?
ERASAlberta uses an implementation approach grounded in clinical knowledge translation1 and patient engagement2. Each ERAS site is resourced and accountable to
- Establish an interdisciplinary site team; a surgeon, an anesthesiologist and operations leadership.
- Integrate and organize site implementation activities through a dedicated ERAS Nurse Coordinator.
- Participate in creating provincial clinical pathways3 with justified local variations.
- Align the eligible ERAS surgical patient population(s) at the site with international ERAS guidelines.
- Map the perioperative patient care journey from pre-admission to discharge.
- Assess current care practices against international ERAS guidelines and clinical pathways.
- Identify opportunities for clinical practice change and quality improvement.
- Provide ongoing nursing and allied health staff, and resident and physician education.
- Collect baseline and ongoing clinical data in the ERAS Interactive Audit System (EIAS).
- Focus on ongoing data-driven clinical practice changes and quality improvement cycles.
- Utilize ERASAlberta provincial and site performance reports linking EIAS and system data.
- Contribute to integrated research and evaluation activities including patient and provider feedback, and provincial, national and international knowledge exchange.
Benefits of ERAS in Alberta
After major surgery, ERAS colorectal patients in Alberta were found to experience less major surgical, lung, and heart problems, with better outcomes and savings to the healthcare system. The six original ERAS sites in Edmonton and Calgary have shown elective colorectal ERAS patients were discharged up to an average of 2.3 days sooner than similar non-ERAS patients. Through the efforts of the ERAS site teams, adherence to the ERAS colorectal guidelines rose from 40% to 65% between 2013/14 and 2015/16. Between 2013 and 2015, ERAS colorectal implementation demonstrated conservative realized net savings of $3.6 million; a gain four times greater than the implementation investment.
ERAS 2016-2018 Implementation
Implementing ERAS is a priority within the Surgery SCNTM Provincial Surgery Plan which aims to transform surgical care and support Zones to meet provincial targets. Between 2016 and 2018, elective colorectal ERAS is being sustained at the Foothills Medical Centre (FMC), Peter Lougheed Centre, University of Alberta Hospital (UAH), Royal Alexandra Hospital (RAH), Miscericordia Community Hospital, and Grey Nuns Community Hospital; and implemented at the Red Deer Regional Hospital Centre, Chinook Regional Hospital, and Rockyview General Hospital. Implementation of multiple international ERAS guidelines is underway at FMC, RAH, UAH with additional guideline implementation at select other sites between 2016 and 2018.
1Clinical knowledge translation is a process to apply research findings and other evidence to create clinical pathways and improve patient care and health services leading to better patient and system outcomes.
3Clinical pathways are an outline of best practices based on published evidence and clinician expertise that guide the patient care journey from pre-admission to discharge, and include clinical knowledge topics, order sets, documentation, decision algorithms, patient education resources.