Context
Central Gippsland Health Service (CGHS) in a partnership with Gippsland Regional Integrated Cancer Services (GRICS) commenced a Colorectal Cancer Audit and Enhanced Recovery after Surgery (ERAS) Implementation Program in September 2012.
Colorectal cancer accounts for 15% of all new cancers diagnosed in Gippsland. At CGHS many of these patients undergo major abdominal surgery, often performed by a general surgeon; resulting in a wide disparity in LOS figures and patient outcomes, for each clinician when compared to state averages.
Evidence-based consensus reviews conducted by CGHS strongly supported the adoption of ERAS care principles to patients undergoing colonic resection for colorectal cancers. Victorian metropolitan experiences support the facilitation of ERAS programs.
Objectives
ERAS places the patient at the centre of the surgical experience with extensive patient education regarding expected outcomes that enable the patient to ‘drive’ their own care post operatively The ERAS experience includes a number of evidenced based interventions, which challenge historical practice, and include:
• Limited or no bowel prep
• Fluid and Carbohydrate loading with only 2 hours fasting preoperatively
• No nasogastric/ drain tubes
• IV fluid restriction with IV fluids removed in Recovery
• Mobility pathways with set targets e.g., sitting out of bed the evening after surgery for two hours, and ambulating on day one
• Fluid and Food intake as soon as wanted post operatively
• Pain buster for post-operative pain +- PCA
Key messages
A strongly multi-disciplinary approach has enabled the successful implementation of our ERAS program, led by a clinical champion.
Conclusion
Analysis of 18 months pre-intervention data with post-intervention data will drive the expansion of the program to all surgical clinicians employed by CGHS with ERAS targeted in our strategic plan to become a whole of organization approach to not just colorectal surgery, but a number of other clinical areas.