Healthier You

“This team approach has a
huge benefit – everyone works in
conjunction, with the goal of best
patient care in mind,” Garth says.
“Patients themselves take a larger role
and responsibility in their care. They
are given more information than ever
before about what to expect with their
surgery, before, during and after. They
are really willing partners in their
treatment and recovery.”
Enhanced Recovery was introduced
within Interior Health in 2011,
through a pilot project at Kelowna
General Hospital led by Dr. Ron
Collins, which focused on colorectal
surgery. Colorectal was chosen because
research is strong in this area and
indicated that patient outcomes can
be improved by implementing an
Enhanced Recovery program.
It was a groundbreaking initiative
because the actions associated with
Enhanced Recovery challenged
traditional practices, such as:
carbohydrate loading before surgery, as
opposed to starving patients; chewing
gum in post-op, and feeding people
earlier, to stimulate bowels; speeding
up mobility by encouraging patients
to walk from the stretcher to his or her
bed; and removing the catheter earlier.
Dr. Collins and his team began
seeing positive outcomes from the
work. Length of stay for patients
started to decrease and patients
expressed higher level of satisfaction by
being more involved and accountable
in their care.
“I think the real success of ERAS
is that it demonstrates how a
multidisciplinary team of committed
front-line providers can positively
impact the health-care system,” Dr.
Collins says. “This initiative very
deliberately mobilized patients to
participate more actively in their own
recovery, and they prove to be willing
and capable partners. We also now
clearly understand that many, if not
most, complications can be avoided by
changing the way we provide care.”
Others in Interior Health took notice
of KGH’s results. By October 2013,
through the sponsorship of Doctors
of BC’s Special Services Committee,
ERAS had spread to six other hospitals:
Royal Inland Hospital in Kamloops;
Penticton Regional Hospital; Vernon
Jubilee Hospital; Kootenay Boundary
Regional Hospital in Trail; East
Kootenay Regional Hospital in
Cranbrook; and Cariboo Memorial
Hospital in Williams Lake. Each site
has introduced ERAS in varying ways,
depending on what best suited their
individual hospital and patient needs.
Royal Inland in particular was an
enthusiastic participant and has shown
great gains. For example surgical site
infections have dropped by nearly 65
per cent, and the average length of
patient stay has dropped to 5.2 days,
from 7.6 days before ERAS.
One reason Royal Inland has
been able to excel is that it has
coupled its Enhanced Recovery
program with its National Surgical
Quality Improvement Program
(NSQIP). NSQIP is a data-driven,
outcomes-based surgical quality
improvement program that enables
hospitals to identify opportunities
for improvement for patient care and
outcomes. The program follows the
entire surgical patient’s journey from
pre-operative, through intra-operative,
to 30 days after their surgery.
Donna Lineker, Royal Inland’s
manager of post-anesthetic recovery,
day care surgery and pre-surgical
screening, says the key to the
Kamloops hospital’s success has been
the teamwork of the care providers,
championed by surgeon Dr. Tom
Wallace.
“It’s a group effort. The entire team
is doing what’s best for the patient,
based on good, scientific research and
best practice,” Donna says. “It makes it
easy. Everyone knows the expectations
and can see the results. Patients are
going home in two-and-a-half, three
days, and they aren’t coming back.
This is excellent quality patient care
that is patient-centred.”
The proof is in the patient
feedback. Consider these
follow-up comments from
patients:
“Excellent personalized care. Had
great follow up by surgeon, surgical
resident, anesthetist, recovery room
nurse and nurse in charge.”
“Excellent nursing care. They really
helped me mobilize which sped my
recovery.”
“(Enhanced Recovery) was pivotal in
my recovery and it should be used
in all surgeries it is applicable to.
It provided me and my family with
all the information we needed to
be comfortable and ‘in the know’
with my recovery and all the steps
along the way. This was a ‘top
notch’ experience and I fully credit
(Enhanced Recovery) with my great
outcome and surgical experience.”
Interior Health’s success with
Enhanced Recovery has made it a
provincial leader in the initiative. In
November 2014, Royal Inland and
Kelowna General joined the Provincial
ERAS Collaborative, which is cochaired
by Garth and Dr. Collins,
along with Dr. Ahmer Karimuddin,
general surgeon at St. Paul’s Hospital
in Vancouver. The Collaborative’s
goal is that every patient undergoing
surgery in B.C. will be part of an ERAS
pathway as part of his or her surgical
experience.
“People know this is the best way
to practice,” Garth says. “We know
that complications are avoidable,
and improved ‘processes of care’
equate to improved results. We are all
accountable for our patients’ outcomes
– and the multidisciplinary approach
of Enhanced Recovery has shown to
result in positive outcomes.”
More info:
Please visit
www.enhancedrecoverybc.ca
spring 2016 Healthier You 23