Bellvitge Hospital applies an innovative protocol that improves the preoperative and recovery of patients after surgery

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So far 1,500 patients have benefited from the ERAS program, which is launched one month before the intervention and which has managed to reduce hospital stays by between 24% and 64% with a high rate of patient satisfaction.

Five hospital services have already implemented the set of protocol measures and six more are in the process of being implemented

The Enhanced Recovery after Surgery protocol, ERAS in its English acronym, includes a series of innovative strategies and measures, supported by clinical evidence and applied from preoperative to postoperative, with the aim of reducing patient stress , the complications that may arise during admission and favor their functional recovery, and as a consequence the length of stay in the center.

The program, which was born in the 90s in northern Europe, began to be applied in 2018 in the Colorectal Surgery Service.

Since then it has been in continuous expansion in the center. Four other services have already fully incorporated the ERAS protocol into their surgical interventions: Plastic Surgery, Urology, Thoracic Surgery and the implantation of knee and hip prostheses carried out by the Orthopedic Surgery and Traumatology Service. This has led to 1,500 patients being discharged from the Bellvitge Hospital with the application of the ERAS protocol. Up to 6 more surgical procedures are in process to achieve full ERAS implantation in the coming months: pancreatic surgery; angiology and vascular surgery; heart surgery; spine surgery; maxillofacial surgery and head and neck surgery.

As a result of the overall improvement of the operative process, the mean stay of patients is significantly reduced, but without an increase in visits to the Emergency Department or subsequent readmissions, a key factor, as highlighted by José Jerez, advanced practice nurse and coordinator of the ERAS protocol at the Bellvitge Hospital. With very high levels of satisfaction, urology patients have reduced the days of postoperative admission by 64%; those of colorectal surgery 50%; those for hip replacement 42% and those for plastic surgery 24%.

The ERAS protocol begins one month before the scheduled date for the intervention with the prehabilitation program, which aims to achieve the best functional state of the patient from a physical, cognitive and nutritional point of view. Through a first consultation, the coordinating nurses carry out a screening of the patients to detect any risk in the three mentioned areas. If everything is normal, the patient receives verbally and with printed and audiovisual material the guidelines to follow to arrive in the best possible state on the day of the intervention. A continuous control system is then put into operation, since the patient has from the first day the direct telephone number of his nurse.

The development of the ERAS protocols continues during the intervention and postoperatively with a series of clinically endorsed measures and in some cases very innovative, such as breaking the fasting hours prior to the operation with a sugary drink or getting the patient to Get out of bed and start taking liquids or food the same day as the intervention. "The patient is admitted optimized and with some 'homework' that he knows he will have to do throughout the process. In this way we have a more independent and more satisfied patient because he recovers much better," explains José Jerez, adding that the program has taken even more relevance with the pandemic, since "reducing post-surgical complications favors the recovery of the patient and reduces their stay in hospital."

The application of the ERAS protocols at the Hospital de Bellvitge is the result of the multidisciplinary work of surgeons from different specialties, nursing professionals, anesthesiology, endocrinology, nutrition and dietetics, physiotherapy and pharmacy.

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