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Melanie Cole: Welcome. This is a podcast series by Deaconess, The Women's Hospital, a place for all your life. I'm Melanie Cole and today we're discussing enhanced recovery after surgery programs and joining me is Audrey Cornelius. She's a Physician Assistant at The Women's Cancer Center of Deaconess, The Women's Hospital. Audrey, I'm so glad to have you with us. This is a great topic and it's really a burgeoning initiative all around the country. Tell us a little bit about what ERAS is. Enhanced Recovery After Surgery. What does that mean for the listeners?

Audrey Cornelius: Exactly as you said, ERAS is also called Enhanced Recovery After Surgery. This is a program that offers guidelines to follow before, during, and after surgery to help patients recover faster and to return to their normal life as quickly as possible. So like I said, we do several things that start at the level of the office before the patient ever gets to surgery. We do things in the pre-op area before they go back to surgery. We do things in surgery, that enter-op period, and then post-operatively. The protocols that we follow are geared to helping patients recover quicker and get home sooner.

Host: So then let's talk about what they're geared toward. What's the rationale behind this? Explain a little bit about programs in general, these enhanced recovery programs. What's the rationale? What have they been shown to do?

Audrey Cornelius: The benefits of ERAS to the patients, in addition to quicker recovery, going home sooner. Patients are at decreased risk of constipation, decreased risk of nausea, vomiting, decreased risk of post-op pain. They are at decreased risk of infection.

Host: So then tell us why the Women's Hospital implemented the ERAS program. Why did you all see a need for this type of program?

Audrey Cornelius: All of our care is really centered around our patients and anything that we can do that allows our patients to have better outcomes, quicker recoveries, less complications, we're going to do that. And we had been studying a lot of other facilities that have implemented this and they had been audited and reviewed, and we're seeing significant reduction and post-op pain and complications. And it was something we really wanted to get behind for our patients.

Host: So who's involved in the ERAS team? You mentioned in pre-op, you even mentioned the office visit before, even surgery starts. Tell us a little bit about the team as it works its way through for the patient and what benefits have you seen as a provider since you've implemented this?

Audrey Cornelius: ERAS is really a team approach. It involves multiple people like I said and several different times during a patient surgery experience. So it all starts in the office with the surgeon and his team, which includes physician assistants, nursing staff, surgery schedulers and so forth. And then it also includes the staff at the hospital, the pre-op nurses, the anesthesiologists, the nursing circulators, the nurses on the floor. We're all involved in implementing this program to optimize patient outcomes.

Host: So tell us a little bit about the impact of these programs. What have you seen and what have patients told you about the way that this is all working for them and their after recovery outcomes?

Audrey Cornelius: The biggest thing I've personally seen in our patients is the reduction in postoperative pain. Our patients are requiring zero to minimal narcotic medications after their surgery and we know that less pain after surgery means patients feel better. They start eating right away, they start moving right away, they recover quicker.

Host: Tell us a little bit about what this actually means, some of the strategies that you're using post operatively and preoperatively. What does it mean? How are you preparing a patient with ERAS? What are you doing with the patient that changes these outcomes so dramatically?

Audrey Cornelius: The first thing, like I said, is their initial office visit, which involves meeting with the surgeon and his team and really educating and counseling the patient on how to prepare for surgery. The patient themselves is a big factor into making this all work, things that they can do starting at home, which is staying active, starting a bowel regimen, eliminating prolonged fasting before surgery. We actually allow the patients to drink clear liquids up to five hours before their surgery. This was not heard of back in the day with a traditional surgery, so that is some things that we start before the surgery. On the day of the surgery, we actually give the patient medications preoperatively to prevent pain before the first incision is even made. During surgery, we also add local anesthetic at the incision sites. And this also aids in preventing treating pain because we're treating pain before and during the surgery, patients are having less pain after surgery. When you have less pain after surgery, you eat better, you eat more, you get up and start moving, and less pain, better nutrition, increased activity. That is what makes patients feel better. They heal quicker, they get home sooner.

Host: Isn't that amazing? And what about after they get home post-discharge? What do you see as the uses for ERAS? In that case? You talked about pain management, but sometimes there's catheters and sometimes there's home care needed. We don't want re-admissions to the hospital. So what happens after they're discharged? How does this help that?

Audrey Cornelius: We know that when we initiate and implement ERAS that patients don't stay in the hospital as long. And for most people after surgery you can count on every day in the hospital equaling a full one week of recovery. So even if a patient goes home now, one to two days before they used to, that is several weeks less of recovery time. So we're seeing patients back in the office one week, two weeks later, feeling great, not having constipation issues, and not having nausea, wounds healing better because patients are eating general diet, having good intake.

Host: Before we wrap up, what would you like patients to know about ERAS and what questions that you'd like them to ask you and members of your team about this initiative before they are going in for surgery?

Audrey Cornelius: The biggest thing, we want patients to be aware of is what ERAS is, what it can do for them. Because really the patient is the center of all of this. On our side. We can only do so much. We can educate and counsel the patient on many of these things, but it really takes active patient involvement, starting at home with the instructions we give them, making sure that they do that at home to optimize their own bodies before undergoing surgery. And then once they're at the hospital, it really takes a lot of involvement on their part by starting that general diet and eating by getting up and walking, being out of bed, and then once they're home, continuing those things, continuing bowel regimens, continuing activity, walking around a lot. So patients need to be aware of what they can do to aid in their recovery. And they are the center of all of this.

Host: Well, they certainly are, and it's really such a multidisciplinary approach. What a wonderful initiative. Thank you so much. And the next time you have surgery, please speak with your doctors about steps to promote enhanced recovery. As always, to learn more about The Women's Hospital, please visit deaconess.com/twh for more information on ERAS and to get connected with one of our providers. And that wraps up this episode of The Women's Hospital, a place for all your life. Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts. I'm Melanie Cole.