The surgical team at New Hanover Regional Medical Center has adopted a program that reduces complications, helps patients recover faster and reduces the likelihood that they will have to come back to the hospital.
The Enhanced Recovery After Surgery (ERAS) initiative at NHRMC helps patients better understand their surgery from pre-surgery to recovery, with the Surgical Home Manager playing a vital role in guiding the patient through the surgical process.
ERAS, which includes surgeons, the anesthesia department, and all care team members, was implemented at NHRMC with one colorectal surgeon in 2016. That success led to expansion to all colorectal surgeons and the adoption of ERAS in urology, gynecologic oncology, cardiac, spine fusions and other surgeries. Further expansion is planned for the near future with two pilot programs currently in development.
The patient’s relationship with the Surgical Home Manager starts with establishing expectations in a consultation one to two week before the surgery. At this appointment, we provide patients with the information they need to prepare for the surgery. We let them know our plan for managing their pain throughout the process, and we set the expectation for discharge after surgery. Patients are educated about what to expect and what they can do to achieve their best outcome.
Just before surgery, the Surgical Home Manager reviews the process with the patient. Our anesthesiologists then provide non-narcotic medications before surgery that help control the pain for up to four days post-surgery. We let our patients know that we are working to control the pain, but that some pain is normal after surgery.
Limiting the use of narcotics enables patients to get out of bed sooner and speeds the recovery processes. Understanding the criteria for discharge often motivates patients to actively participate in their own recovery. For example, immediate walking is vital to the patient's recovery and is highly encouraged. Patients start walking for short sessions the day of their surgery, progressing to multiple laps on the floor. With movement, anesthesia leaves the body, systems begin waking up and bowel function is restored. Patients on narcotics who remain in bed are more susceptible to complications such as pneumonia, blood clots, or bowel obstruction.
After a patient leaves the hospital, the Surgical Home Manager stays in contact with them throughout recovery. Patients are encouraged to call if they have any concerns. We are committed to helping patients avoid complications that could lead to another trip to the hospital and a readmission.
The ERAS program offers three primary advantages: decreased complications, faster return to functionality and reduction in opioid use.
Feedback surveys reflect better patient satisfaction since the ERAS program was started at NHRMC. Surgeons are also excited that their patients recover faster, experience better outcomes, and have a point of contact to help navigate their care.
The Surgical Home ERAS program has shortened length of stay. For instance, colorectal surgery patients used to spend 6-10 days in the hospital. Now, they return home within 2-3 days. Of course, this outcome does not apply to every patient. If discharge is not safe and the patient is not medically ready, we keep the patient hospitalized. We would never want to discharge a patient, have them experience a complication, and then come back to the hospital for readmission.
Complications in colorectal surgery patients have been reduced by about 70 percent, and readmissions are down by 75 percent since the ERAS program began in 2016.
Significant reduction in opioid use
Another significant component of the ERAS program is a reduction in the use of narcotics. By attacking surgical pain in ways that involve minimal use of narcotics, patients in the ERAS program go through their hospitalization with significantly less opioid exposure. Therefore, the Surgical Home/ERAS program at NHRMC is significantly contributing to the progress on NHRMC’s system-wide initiative and to the well-being of our community.