My name is Marita and I run the Enhanced Recovery After Surgery programme (ERAS) for cardiac patients here in Brighton & Sussex University Hospitals. I started working for the trust in 2000 on the general Intensive Care Unit moving to the Cardiac Intensive Care Unit in 2004. When the opportunity came up to be able to bring ERAS to our cardiac surgery patients I knew that I wanted to take the project on!
I started the new role in April 2018. For the first month I concentrated on researching enhanced recovery in surgery. With input from colleagues I created the ERAS logo (incorporating the Sussex Heart Charity logo), a patient booklet, education poster, management guidelines for staff and a criteria for assessing which patients would be suitable for the programme. I spent time educating all members of the multi- disciplinary team ready for our first patients.
What is Enhanced Recovery After Surgery?
The aim of the Enhanced Recovery After Surgery (ERAS) programme is for patients to return to full health as soon as possible after their operation. Research has shown that the earlier a patient gets out of bed and start eating and drinking the quicker their recovery.
The programme begins before the operation, progresses whilst in hospital and continues when back at home.
There are many ways a patient can speed up their recovery. The ERAS booklet increases understanding of the ERAS programme and enables the patient to take an active role in the preparation for surgery and recovery after.
Healthy living goals in the weeks before surgery aid a quicker recovery and fewer complications.
· Fruit and vegetables – aim to eat at least five portions a day.
· Protein rich foods such as lean meat, fish, eggs, lentils, nuts, beans.
· Starchy foods such as rice, bread, pasta and potatoes. Aim for wholegrain varieties when you can.
· Milk and dairy foods.
· Limit foods which are high in sugar, fat and salt.
· If the patient feels well enough, exercise will help make sure their body is as fit as possible before surgery. If they are already active, keep up with normal exercise / activity routine. If not, they should start slowly adding exercise into their day. A 15 minute walk is better than not exercising at all.
· Get practising
· We like the patients to start practising the exercises they will be doing after surgery.
· The patient will have a wound down the centre of their chest over the breastbone. An important part of the wound and bone healing is the restriction of the activities they can do with their arms after the operation. This is because certain activities can put a lot of stress on the bone trying to heal.
We like patients on the ERAS programme to start thinking about their discharge before coming into hospital. Recovery at home will continue for some time after discharge and therefore it is important to think about how they will manage in the weeks after surgery.
Within the ERAS booklet is the patient diary, which is intended for use whilst in hospital to give the patient an opportunity to take an active role in their care and assist by enhancing their recovery. The patient is able to note down thoughts and feelings throughout their hospital stay plus document the enhanced recovery goals of early nutrition and early mobilisation.
The diary is designed for the patient to complete but family, friends and members of the team can assist if required.
The diary sets out guidelines on what to expect on the days after surgery. However, as everyone is an individual, the patient’s journey may vary slightly from the programme set out. This does not mean the patient has failed, it is purely a variation to the programme.
The aim of the ERAS programme is to increase patient satisfaction with care, reduce post operative complications and reduce length of stay in hospital.
Once the patient is home I aim to contact them within 3 days and monitor their recovery plus provide support until either their cardiac rehab starts or they have their 8 week outpatient appointment.
I audit the programme and create a monthly email for staff to feedback patient comments and issues that have been picked up. I have already found out that being discharged home after 17.00 can really impact how a patient recovers in their first few days at home. I have taken steps to streamline the discharge process and aim for discharge before 14.00. Patients have also had issues regarding adequate pain relief at home so I am working hard to ensure patients are assessed and prescribed the correct pain relief on discharge.
I started taking patients onto the programme in May 2018 and so far had 55 patients follow the programme. My aim is to have 150 – 200 patients in 12 months. With the data I collect I continually review the programme to ensure best practice. I am attending the ERAS UK conference in November and hope to visit other cardiac surgery units who also run an ERAS programme to share ideas and areas of improvement.
The support from the Sussex Heart Charity has been amazing and the support from all my colleagues has meant the programme has been going really well. Feedback from my patients has been positive. I look forward to supporting more patients through their cardiac surgery journey.