Interested in a faster recovery after surgery?
Nutrition is just one of the “secret weapons” Baptist Health is using to help surgery patients spend less time in the hospital and get back to normal activities sooner.
March 14, 2019 | Jacksonville, FL
For years, patients have been told to fast the night before surgery. Nothing by mouth or NPO after midnight has long been the standard practice.
But that was then and this now. Based on clinical research, health care providers are starting to embrace an innovative new set of protocols known as Enhanced Recovery After Surgery (ERAS), which emphasizes nutrition, fluids and activity, and minimizes practices that can place stress on the body during and after surgery.
“ERAS is becoming the new standard for patient care before, during and after surgery. It’s a game-changer,” said David Rice, MD, senior vice president and chief quality officer for Baptist Health. “Baptist Health began implementing ERAS in 2017 and we have seen significant improvements in patient outcomes, length of hospital stay and recovery times.”
Baptist Health found that when it compared the outcomes of ERAS versus pre-ERAS patients having elective colorectal surgery, ERAS patients needed 21 percent less pain medication and spent two days less in the hospital. Also, 80 percent of the ERAS patients were up and out of bed the day of surgery, versus less than 20 percent of pre-ERAS patients.
“We have fully implemented ERAS in four specialties so far and plan to spread it to every service line as quickly as possible. But we’re not stopping there,” said Francine Marabell, MSN, director of safety and quality at Baptist Health. “We’ve changed our guidelines to eliminate fasting before midnight for all possible surgeries, which is a major step toward helping more patients recover faster.”
Implementing ERAS requires a concerted effort by health care providers in many disciplines, as well as the participation of the patient. Because patient education is key, Baptist Health patients are encouraged to receive information from a Pre-Admission Clinical Evaluation (PACE) nurse prior to their scheduled appointment for surgery. Patients learn what to expect before, during and after surgery.
The four key components of ERAS at Baptist Health are:
- 1. Starting to prepare the body as soon as surgery is scheduled. Patients are encouraged to start preparing by getting regular exercise (walking at least 15 minutes a day) and eating a well-balanced diet with a recommendation of at least 60 grams of protein a day. Those who smoke, vape or chew tobacco are strongly encouraged to quit, because it will slow down their ability to heal.
- 2. Encouraging clear liquids and “carb-loading” before surgery. Instead of fasting after midnight, new research shows that patients do better when they are allowed to have clear liquids up to two hours before scheduled arrival time for surgery. Some patients are also given a clear pre-surgery carbohydrate drink to help them maintain good blood glucose levels during surgery. This is similar to how runners use “carb-loading” to prepare for a race.
- 3. Comfortably managing pain with limited use of opioids. Targeted pain management and careful management of IV fluids during and after surgery reduces the use of narcotic painkillers and helps patients avoid side effects such as nausea, dizziness and constipation that can stress the body.
- 4. Stimulating recovery with activity and nutrition. Instead of emphasizing bed rest, patients are encouraged to drink, eat and move as soon as possible. ERAS patients are encouraged to sit in a chair more than in the bed, and walk to stimulate healing and digestion.
“All surgeons want the best outcomes for their patients and ERAS can help accomplish that,” said Craig Morgenthal, MD, vice chair of the Department of Surgery at Baptist Medical Center Jacksonville. “But ERAS is not something you can do alone. Everyone has an important role to play, from the surgeons to the anesthesiologists to the nurses and patients. We all have to work together to have the best surgical outcomes.”
For more information, visit Baptistjax.com/ERAS.