New Program ‘Enhanced Recovery After Surgery’ (ERAS) Speeds Recovery for Colorectal Patients

A Patient-Centered Care Approach

A new program has launched to advance the recovery process for colon and rectal surgery patients at Lee Health. “The patient-centered, team-based model of care known as ‘Enhanced Recovery After Surgery (ERAS) provides preoperative classes for patients on what they can do before surgery to optimize their recovery.

These classes also educate patients and their families on what to expect throughout the course of their hospitalization,” says Jeffrey Neale, M.D., colorectal surgeon and an ERAS physician team leader. “There are multiple components of ERAS. In addition to preoperative classes and preoperative supplements, a non- narcotic centered approach to pain management is incorporated into the patients care. Using new technology, patients are given IV fluid specifically for their own needs. This, along with feeding and getting the patient up and moving early after surgery, is core to the success of the program.”

Over the past year, colorectal surgeons, general surgeons and anesthesiologists, physician assistants and nurse anesthetists at Cape Coral Hospital, combined with the nursing staff, pharmacy, nutrition, technical support team and administration have put in hundreds of hours designing the ERAS program.

In April of 2016, Cape Coral Hospital applied the ERAS method to its first colorectal surgery patient. The program is now implemented at Gulf Coast Medical Center and Lee Memorial Hospital and involves several subspecialties of surgery.

Lynn Mayle, R.N., M.S.N, is a clinical educator and an instructor of ERAS classes. “This new method moves away from the traditional ways of taking care of patients,” she says. “One aspect is that they are no longer restricted from drinking after midnight. Now they are allowed to drink clear liquids up to 2 hours before surgery and are given carbohydrate loading drinks to take the evening before and in the morning of their surgery to decrease insulin resistance, which in turn decreases the risk of surgical site infection. The program has improved outcomes for our surgery patients and we have received positive feedback from our first ERAS class of 20 individuals.”

Following D.R.E.A.M

In the patient education classes, patients participate in ERAS by following D.R.E.A.M:

  • D - Optimization of a healthy diet with protein supplements and carbohydrate loading before surgery to decrease insulin resistance and the chance of surgical site infection
  • R - Reduce stress, physically and emotionally through ERAS classes where you learn how you can play an active role in caring for yourself before surgery through to recovery
  • E - A – Early Ambulation gets you moving, standing and walking around very soon after surgery
  • M – Minimization of opioid use through a multimodal approach, which is using two or more medications targeting different areas of pain in the body and the use of non-narcotics to get your body back to functioning quick

Marilyn Kole, M.D., M.B.A., system medical director of clinical transformation agrees that this combination of patient and family education through classes, standardizing evidence-based colon and rectal surgical care and involvement of the entire healthcare team, is a winning combination for patients. “ERAS classes answer the ‘whys’ patients have in the surgical process,” she says. “Patients are better prepared which decreases their stress level and increases satisfaction – the average length of stay has been reduced by more than a day and a half and so far, we have had a very low surgical site infection rate.”

Marilyn Kole, M.D.
Gulf Coast Medical Center
13681 Doctor’s Way
Fort Myers, FL 33912

Jeffrey A. Neale, M.D.
The Colorectal Institute
13770 Plantation Rd.
Suite 2
Fort Myers, FL 33912

Tags: surgery, patient-centered care, colorectal surgery, ERAS, Gulf Coast Medical Center, Lee Memorial Hospital