March 2nd, 2017
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February 28, 2017 (Kitchener) – Thanks to an innovative approach at St. Mary’s General Hospital, cancer patients having part of a lung removed are going home the same day or next day, rather than staying two-to-five days in hospital.
The model is called Enhanced Recovery After Surgery (ERAS) and St. Mary’s is believed to be the first Canadian hospital to fully implement it for lung cancer patients. Since August 2016, more than 50 patients who have undergone minimally invasive thoracic (lung) surgery at the hospital have benefited from the early discharge approach.
ERAS maximizes the patient’s chances of quick healing and recovery through a strict pre-operative regimen of exercise, healthy eating, pain medication and smoking cessation. During surgery, local anesthetic nerve blocks are used rather than an epidural, allowing patients to be mobile and comfortable soon after surgery. They are given fewer narcotics, resulting in less post-operative drowsiness, nausea and dizziness. Fewer intravenous fluids reduce the chance of a post-surgery injury to their lungs.
Within an hour after surgery, patients are up walking in the recovery room, with the help of a family member and are given food to boost their strength. When they arrive on the Chest Unit, nurses and a family member help them walk every hour until bedtime. Discharge for patients who have a small wedge of their lung removed is planned for the same day, rather than the previous two-to-three days. For those who have a lobe of their lung removed, discharge is planned for the next morning, rather than the previous four-to-five days post-surgery.
“This approach requires a paradigm shift in attitude for patients and staff,” says Dr. Paul Chiasson, a thoracic surgeon at St. Mary’s. “You have to see it to believe it.”
“St. Mary’s is ahead of the curve,” adds Matt Dubuc, a Nurse Practitioner on the Chest Unit, who has a dual role, assisting thoracic surgeons in surgery as a Registered Nurse First Assistant. “Some centres are doing parts of ERAS for thoracic surgery. To our knowledge we are the only centre in Canada to fully implement ERAS for video assisted lung cancer surgery,” says Dubuc.
St. Mary’s is a Level One Centre for Thoracic Surgery, completing a minimum of 120 lung cancer surgeries per year. After learning about a hospital in Virginia using the enhanced recovery model for lung cancer patients, a St. Mary’s team travelled there in April of 2016 to learn more. After much planning, the team introduced ERAS at St. Mary’s four months later. The Virginia group has since visited St. Mary’s, and is interested in incorporating some of the St. Mary’s approach into their program.
The ERAS model relies on another St. Mary’s innovation, the Integrated Comprehensive Care Program, to provide a home visit from a nurse prior to surgery to ensure patients have complied with the required preparations. A follow-up home visit occurs a day after discharge, and care coordinators are available by phone 24/7 to assist with any questions for up to 60 days. Patients visit their surgeons one month later to see how they are recovering. “Patients feel empowered to help themselves get better and families feel important to the process,” says Dr. Chiasson. “There is a marked reduction in post-operative complications and hospital stays are shorter, saving health care dollars. Patient satisfaction is greatly improved with a quicker return to home and work.”
Clinical Nurse Educator Christa Saunders adds that the support and encouragement patients receive prior to surgery helps motivate them. “These patients are determined by the time they arrive for surgery that they are not going to spend several days in hospital,” says Saunders.
Anne Kelly, Manager, Communications
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