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Physician Update - A Quicker Rebound
Physician Update Fall 2014
A Quicker Rebound
Date: November 12, 2014
With ERAS, Elizabeth Wick and Christopher Wu hope to decrease hospital stays and improve patients’ experiences.
A new approach to colorectal surgery care, which has been shown to decrease hospital length of stay by 50 to 60 percent, has gotten the green light at Johns Hopkins, where a team began implementing it earlier this year.
Known as the ERAS (enhanced recovery after surgery) pathway, it encompasses the preoperative, intraoperative, postoperative and post-discharge phases of care, as well as a standard perioperative anesthetic plan.
Under the plan, nurses work closely with patients before surgery to provide print and electronic educational materials, supplies for surgery preparation, checklists and instructions. “It engages the patient much more in their care,” says surgeon Elizabeth Wick.
Then, during surgery, to avoid anesthetic gases, intravenous fluids, and postoperative nausea and vomiting, “we are trying to use modalities like epidural anesthesia and propofol infusion,” says anesthesiologist Christopher Wu. “And when patients are ready for oral medications, we use nonopioid agents, like NSAIDs, as well as other non-narcotic painkillers.”
Postoperatively, nurses encourage patients to drink the proper amount of fluids, to get out of bed more quickly, to get moving and to eat.
After just a few weeks, the results were encouraging: Length of stay decreased by two days compared to the average of the previous six months, and patients seemed to feel better. “Their pain is under better control,” says Wu. “They are eating sooner and are ready to go home.”
If clinical data show that ERAS is successful for colorectal surgery over time, the same techniques could be applied for other surgical procedures in the abdomen. “While the pathway regimen would differ, the concept is very similar,” says Wu. “A program like this takes a team of champions across disciplines who work well together and have good communication.”