Authors (including presenting author) :
csf111(1)Department of Surgery, Princess Margaret Hospital (1)
Affiliation :
PMH department of surgery
Introduction :
Patients after surgery usually suffer from long length of stay and serious post-operative complications. In light of the aforesaid the ERAS (Enhanced Recovery After Surgery) programme has been launched in October 2020 to aid patients undergoing major and ultra-major operation namely colorectal, hepatopancreaticobiliary, head and neck, and upper gastrointestinal surgery.
Objectives :
The target patients will benefit in two different ways from the ERAS programme.
To commence, to improve patients’ quality of life through effective pain control, shortened hospitalization and the minimization of post-operative complications. Besides, to contribute to better resource allocation by reducing the readmission rate of surgical patients while also ameliorating patients’ haemoglobin level before operation with the objective of reducing perioperative blood transfusion.
Methodology :
The program is run by an ERAS nurse who essentially assumes the role of a coordinator among various departments.
After patients have learnt about their condition from OPD and have discussed with surgeon about their surgical plan, they will be referred to ERAS nurse.
With the aid of pamphlets and pre-operative video, ERAS nurse will provide pre-operative counseling services all the while conducting pre-operative assessment. Patients will be referred to allied health professionals for rehabilitation and perioperative training. Should the situation present itself, patients may be referred to Monofer infusion in day clinic, medical follow up or smoke cessation centres. When met with patients with special needs, ERAS nurse would refer them to medical social workers to deal with any potential discharge problems including the application of allowances and Old Age Home. Hotline services and telephone follow up are also provided to solve any of patients’ enquiries after discharge.
Result & Outcome :
In the span of 2 years over 860 patients enjoyed our services. There has been a drop in the median length of stay of patients across all types of surgical operation, with the
most significant being colectomy as patients’ median length of stay has reduced by 44% from 9 to 5 days. As reflected from a satisfactory survey, 99% of patients are very satisfied with our services. Currently, 95% of patients are able to attend pre-operative assessment clinic after initial training by allied health professionals. A progressive reduction in readmission rate with 30 days after operation is also observed after. We are currently sitting at 5% readmission rate when compared to last year’s 8% and it is believed that the readmission rate would continue to lock in a downward spiral in the near future.
