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Enhanced Recovery After Surgery

Surgical Services Taskforce and Anaesthesia Perioperative Care Network

Patient Experience – Zoe’s story

Zoe is a patient with multiple comorbidities. She was admitted to hospital with a bowel obstruction. She was approached by the ERAS coordinator about the proposed surgery and asked to participate in the ERAS program.

The majority of ERAS patients are seen in the preadmissions clinic prior to surgery, in order for clinicians to identify ways to optimise their condition. Zoe described ‘prehabilitation’ as optimising her condition before surgery, through identifying comorbidities and involving relevant clinicians early, such as dietetics and anaesthetics. Zoe also needed a blood transfusion to optimise her condition prior to surgery.  

One of the most important components she identified in her preoperative care was education. She was given a comprehensive booklet that explained the ERAS process clearly and set out expectations for each day following the surgery. The implications of any setbacks were also explained, for example, that length of stay would be extended if an ileostomy was needed. Zoe was given instructions to have carbohydrate loading drinks up to two hours before the surgery.

Zoe was able to eat frequent small meals immediately after the surgery. The day following the surgery, she was up walking and the PCA was removed. She had an ON-Q ball for pain relief, which continually delivered local anaesthetic to the site of incision. The physiotherapist visited once per day, including over the weekend.

Zoe completed a diary that identified every time she ate, mobilised and various other milestones post-surgery. She referred to the ERAS program as “surgery bootcamp” and stated that she was determined not to be caught in bed! This was mainly because she was so motivated to meet the milestones that would allow her to be discharged on Day 4. While Zoe was discharged on Day 5 this was still a fantastic outcome, particularly given her comorbidities. The ERAS coordinator called Zoe 1-2 days following her discharge to check on her progress. Zoe was also pleasantly surprised that there was communication to the GP and that she did not have to follow this up herself.

From the patient perspective, Zoe identified a number of benefits of the ERAS program:

  • Patient expectations were set early.
  • Patient was incredibly motivated to adhere to the ERAS pathway.
  • Patient was actively involved in their care – options are made available to them rather than being told what to do.
  • Clear communication – between teams and with the patient. In Zoe’s case, the communication process was also extended to include the oncology team.
  • Doctor took the time to explain all potential scenarios prior to surgery.
  • Poster on ward explained what to expect each day.
  • Very organised process.
  • Expectations were set with family, particularly for at home care after discharge.
  • Clear instructions were given upon going home – for example, no lifting or driving.
  • Follow up appointment (with surgeon and oncologist) was made when discharged – did not have to organise anything.
  • Copy of discharge summary was provided to the patient for their records.