ERAs

Introduced in 1997, Enhanced Recovery After Surgery (ERAS) is a care model that aims to improve patient results after surgery. ERAS techniques focus on:

  • Reducing length of stay
  • Reducing the complication rate
  • Encouraging earlier recovery
  • Cost reductions

Today, ERAS protocols and guidelines are published by the ERAS Society and cover a wide range of surgeries, including colorectal, breast reconstruction, bariatric, liver, pancreatic, and more. ERAS protocols are evidence based and incorporate recommendations from gold-standard studies on factors like anesthesia, pain control, post-operative nutrition, and many other elements that influence how a patient fares after a complex surgery. A growing body of research is validating this approach, showing that trained, multi-disciplinary teams following an ERAS protocol can have a significant impact on patient recovery and well-being.

While most ERAS recommendations are focused on the core medical team, very few studies have looked at it from the patient’s perspective. This needs to be an important part of the conversation—patient education and adherence is fundamental to most ERAS models. One study identified 22 elements that support success with ERAS—including several, like carb loading before admission, that rely on the patients themselves.

In 2017, a group of researchers from Canada published the first review of patient expectations with ERAS. They found that patients supported ERAS but had a few requests:

  1. That protocols are fully explained before the surgery and while in the hospital. Patients wanted to understand why their care providers were doing things like removing drains at certain times, recommending certain diets, and discharging them at a particular time.
  2. That more attention is paid to the presurgical phase, so patients are better prepared emotionally and psychologically as well as physically.
  3. That ERAS guidelines are extended to the post-surgery recovery at home, so patients have a better understanding exactly how they can support their own recovery.
  4. And finally, wherever possible hospitals should establish peer support programs so patients can have access to people who have already had successful outcomes with ERAS.

The central theme is that patients want to be active partners in their surgeries and have a good understanding of what ERAS means and how it will improve their experience. They wanted to “take responsibility” for their own health.

The only way to really accomplish this is through close communication with patients and by offering education they can understand and act on. This means offering education protocols that first explain what ERAS is and why patients should invest in it, then tailoring education plans to track through the process. Our Recommended Learning, which features sequenced structured learning modules,  makes it easy to configure patient education into playlists that match ERAS protocols. Examples of patient education that support ERAS protocols would be:

  • Stress reduction before surgery
  • Information about the specific procedure
  • Pain control (understanding best practices and reduced anesthesia)
  • Nutrition before, during, and after hospitalization
  • Discharge information
  • Test results
  • Home help and therapy

Currently, ERAS is more common overseas than in the United States, but there is strong interest in bringing ERAS protocols to more surgical hospitals here. Including a strong patient education component with any ERAS program can help improve outcomes and make ERAS more effective, while also improving patient satisfaction.

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References

  1. Encare Enhancing Eras, a partner of the Eras. https://encare.net/.
  2. Gillis C, Gill M, Marlett N, et al. Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study. BMJ Open. 2017;7(6):e017002. Published 2017 Jun 24. doi:10.1136/bmjopen-2017-017002
  3. Taurchini M, Del Naja C, Tancredi A. Enhanced Recovery After Surgery: a patient centered process. J Vis Surg. 2018;4:40. Published 2018 Feb 27. doi:10.21037/jovs.2018.01.20