A new mindset in surgical care at South County Hospital is helping patients recover faster, have fewer infections, and reduces the need for opioid-based drugs to manage pain.
In November 2018, physicians at South County Health, in partnership with the Johns Hopkins Institute, implemented the Early Recovery After Surgery (ERAS) pathway, a perioperative model that begins prior to surgery and continues through a patient’s recovery process.
After tracking outcomes, South County Hospital’s patients who received surgical treatment while following the ERAS pathway showed a shorter length of stay in the hospital, less complications, fewer infections and lower incidents of readmission to the hospital.
“We started with 10 patients to closely monitor how they responded to their surgical procedures during the preparation phase through their recovery,” said Lee Ann Quinn, RN. “In the six months of data we have reviewed so far, we’re happy to report zero post-op infections and our length of stay has been cut in half.”
ERAS requires close teamwork among surgeons, anesthesia providers and nurses. In her role as director of Infection Prevention and Control, Lee Ann worked closely with South County Health’s chief of anesthesiology, Dr. Henry Cabrera, surgeons, Dr. Umberto Capuano and Dr. Joseph Brady, as well as nutritionists, pharmacists and other clinical health professionals.
A new mindset
Patients who follow the ERAS pathway are prescribed doses of non-opioid analgesic medications in preparation for their surgery. This component is part of the opioid sparing pathway that was developed by Dr. Cabrera and Dr. Michael Bradley of OrthoRI and South County Health’s chief of orthopedic surgery. That pathway was implemented at South County Hospital in March 2018.
“The opioid sparing pathway proved successful in reducing the amount of opioid’s used for pain management which resulted in reducing or eliminating the negative side effects of those drugs, and reducing their recovery times,” Lee Ann said.
With ERAS, the pain management pathway is followed and patients are given a carbohydrate-loading drink prior to their scheduled surgery, contradictory to the traditional practice of fasting before surgery.
Likewise, the once standard practice of getting bedrest after surgery has also been changed. Using the ERAS pathway, surgical patients are encouraged to get out of bed and become mobile soon after leaving the operating room, all of which contributes to their early recover after surgery.
To develop the pathway, South County Health partnered with Johns Hopkins Armstrong Institute for Patient Safety and Quality, in collaboration with the American College of Surgeons. The partnership makes extensive research, resources and national outcomes data readily available to assist in delivering the ERAS pathway.
“We wanted to adapt the ERAS pathway at South County Hospital if it would benefit our patients like it has in other healthcare systems across the country,” Lee Ann said.
ERAS uses scientific data to enhance the human body’s natural healing ability and return surgical patients to good health with fewer complications. South County Hospital introduced the ERAS pathway to colorectal patients and, given its success, will expand to other surgical specialties.