Internationally recognised Scientist and Plastic and Reconstructive Surgeon, Dr John Semple, is presenting at the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) and the New Zealand Association of Plastic Surgeons (NZAPS) Combined Conference today about protocols that support the safe, earlier discharge of patients from the hospital.
ENHANCED RECOVERY AFTER SURGERY (ERAS)
Dr Semple, who is Professor of Surgery at the University of Toronto, became interested in the ERAS approach in 2006, when the hospital he was working at went from being an inpatient hospital, to the regional outpatient centre.
“Up to that point, we had the privilege of keeping our patients for several days for breast reconstruction, which was the area we specialised. We now had to discharge patients within 18 hours. Some saw a drop from five days down to 18 hours as almost impossible.
“So we put a team together that included patients, anaesthetists, nurses, patients, physios, occupational therapists and others, and worked towards getting a method we could apply to get these patients out of hospital quickly and safely.”
That method included preadmission patient education – including information about their upcoming surgical procedure; giving patients a ‘pre-emptive cocktail’ – a mix of painkillers, anti-inflammatories and sedatives an hour before surgery; nerve blocks during surgery; and telephone advice after discharge such as checking if they are taking their medications and if their dressings were intact.
Dr Semple and his team looked at different aspects of the patient’s recovery after this approach and found there were improvements in some areas including their physical comfort, physical and psychological well-being and daily activity. These improvements meant they recovered well at home.
“People are much happier to recover at home as there are fewer infections and they have the comfort of their familiar surroundings.”
The team also found a patient’s wellbeing before surgery had a big impact on how quickly they recovered afterwards – for example, very thin or very obese patients often had a longer recovery time and were less tolerant to pain.
Dr Semple says in 2018, the approach of using protocols for getting patients out of the hospital earlier – comfortably and safely – is widely used. ERAS is one example of such a set of protocols, but all follow similar principles. Other protocols can include minimising patient fasting before surgery and giving them food as soon as possible afterwards; using anaesthetic techniques that decrease nausea, vomiting and pain after surgery; and getting patients up and moving quickly.
MONITORING RECOVERY AT HOME
Closely linked to earlier discharge, is the need to monitor patients at home. Dr Semple says his team realised they had become pretty good at getting patients out of hospital quickly and safely, but didn’t necessarily know much about their experience once they were home.
“From this came the idea of virtual care and monitoring using mobile devices. At Women’s College Hospital in Toronto, we conducted a randomised controlled trial using a mobile app, to conduct postoperative follow-up care and monitor for complications after breast reconstruction patients have returned home.
“Once patients have been discharged, they answer a series of questions about their recovery using a touchscreen on the phone and take daily photos of their wound site. This information is relayed to a secure and confidential “cloud” data set and becomes available to be reviewed by their health care team.”
The randomised controlled trial found that mobile app follow-up didn’t affect complication rates or patient-reported satisfaction scores, but improved convenience scores.
Dr Semple says current evidence supports substantial time, travel and cost savings to patients, and high satisfaction with the convenience of postoperative monitoring protocols using mobile devices.
“If you’re living in Canada and it’s February and 30 below, and you have to drive 100 kilometres to get to Winnipeg for your follow up, and everything’s fine – you can see the benefit of those virtual follow up visits.”
ASAPS – Julia Power, email: firstname.lastname@example.org or mobile: + 61 414 276 990
NZAPS: Lizzie Price, email: email@example.com or mobile: +64 276 957 744