With pre- and post-surgery requirements, having an operation or procedure can be frightening. Dr. Rekha Singh, chief of surgery at The Hospital of Central Connecticut (HOCC), and her peers across Hartford HealthCare (HHC), have implemented a program to help put those fears to rest.
The program, Enhanced Recovery After Surgery (ERAS), includes interdisciplinary perioperative care pathways to help patients prepare for surgery and recover more quickly. ERAS can be viewed as a continuum of three phases of care: pre-operative, peri-operative and post-operative.
• The pre-operative phase focuses on patient education and preparedness for surgery, including improving the patient’s overall health before surgery to speed recovery.
• The day of surgery concentrates on mitigating surgical stress, including maintaining optimal hydration by not requiring the patient to fast for a long period of time leading up to the procedure.
• The post-operative phase focuses on returning the patient to full function, including eating, walking and working toward a quick transition to home.
Singh said HHC is dedicated to changing and improving the way surgical care is delivered. ERAS makes patients active participants in their recovery. They become members of their care team, which includes the surgeon, residents, APRNs, physician assistants, nurses, patient care technicians, anesthesiologists, CRNAs, surgical technicians, physical therapists, occupational therapists, dieticians, social workers, care coordinators, and environmental services technicians. Together, the team works closely to provide the patient with a safe and comfortable experience.
“We are no longer bound to the traditional but compartmentalized silos of surgery, anesthesia, peri-op, nursing, PT/OT, and dietary,” said Singh. “With ERAS, we function as a truly multidisciplinary team, guiding our patients through their surgical experiences through a standardized and highly coordinated pathway.”
HOCC began its ERAS journey in January 2016, initially with colorectal surgery and subsequently with other specialties, including gynecologic and thoracic surgery. According to Singh, since then, ideas have been shared throughout the HHC system in surgical, anesthesia and peri-operative councils. By the beginning of 2017, the councils and physicians from the five HHC acute hospitals had embarked on a system-wide standardized approach for colorectal surgery through clinical redesign.
Jay Encarnacion, BSN, RN, quality nurse coordinator at Hartford Hospital, was part of the councils’ discussions. Encarnacion said standardization across the system helps everyone practice the highest level of care available.
“Elective surgery doesn’t just include nurses and doctors. It involves nutrition, therapy, pre-admission testing, etc., and we’re all trying to talk the same language,” said Encarnacion. “While it was important to bring the key players to these discussions, we also reached out to every department to avoid conflicting information regarding the patients’ needs.”
MidState is slated to start using the ERAS system-wide protocols later this month.