Tools: Updated Core Process and Outcome Measures for Elective Colorectal Surgery

The aims of a minimum Enhanced Recovery dataset are to facilitate quality improvement and enable cross-site comparisons and learning. Since the close of the Enhanced Recovery Collaborative in January 2016, the SSC and core Enhanced Recovery faculty (Dr. Ron Collins, Dr. Ahmer Karimuddin, Dr. Kelly Mayson, and Garth Vatkin), with critical feedback from the Enhanced Recovery Advisors Network and Collaborative sites, have worked to improve the process and outcomes measures.

The updated, recommended, core Enhanced Recovery process and outcome measures for elective colorectal surgery is now available! Revisions are indicated in red text. Other data collection tools can be found here. Please note that the excel data collection sheet and the run chart tool will also be updated and posted soon.

The process for developing this new version:

  • A survey asking each of the 11 Enhanced Recovery Collaborative sites to provide feedback on the utility of individual measures and provide suggestions to further clarify definitions
  • Revising definitions to be consistent with the Collaborative’s four clinical guidance notes.
  • Integrating feedback from the multi-disciplinary, Enhanced Recovery Advisors Network on the revised draft prior to finalization.

Thank you to everyone who contributed to this resource!

Download (Colorectal-Data-Set_Enhanced-Recovery_20160928.xlsx, XLSX, 26KB)

 

Tools: VGH Radical Cystectomy pathway, patient booklet, order sets

Thank you to Vancouver General Hospital for sharing their new resources for radical cystectomy! The pathway, patient education booklet, pre-op and post-op order sets can be downloaded below.

Click on the following links to find more staff resources, patient education tools, and order sets from other sites.

If you apply any of the documents found on this website to your own settings, please acknowledge the organization that originated the documents in your own versions.

Download (ERAS-Radical-Cystectomy-pathway-Feb-2016_VGH.pdf, PDF, 582KB)

Download (ERAS-Cystectomy-Booklet-July-2016_VGH.pdf, PDF, 863KB)

Download (Radical-Cystectomy-Pre-Op-Enhanced-Recovery-After-Surgery-ERAS-Orders-923.pdf, PDF, 47KB)

Download (Radical-Cystectomy-Post-Op-Enhanced-Recovery-After-Surgery-ERAS-Orders-274-dbl-sd-pg-3-and-3A.pdf, PDF, 50KB)

Webinar: Post Surgical Pain Mgt Techniques – gynecology focus

 

To access a free Enhanced Recovery in Gynaecological Oncology webinar on the topic of Post Surgical Pain Management Techniques for Enhanced Recovery click here. The webinar is presented by The Foundation for Women’s Cancer.

Speakers:

Sean C. Dowdy, MD Professor of Obstetrics/Gynecology, Deputy Director of Practice, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine Rochester, MN

Pedro T. Ramirez, MD Professor, Director of Minimally Invasive Surgical Research & Education, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center Houston, Texas

SSC Enhanced Recovery Fund Recipients

The Specialist Services Committee (SSC) is a joint committee between Doctors of BC and the BC government, with regular representation from health authorities. SSC formed in 2006 under the Physician Master Agreement to help the Doctors of BC, BC government and health authorities collaborate on the delivery of specialist services and support improvement of the specialist care system in BC. www.sscbc.ca

With the close of the SSC-sponsored BC Enhanced Recovery Collaborative in mid-January and Ministry of Health-led conversations about a potential provincial plan underway, the SSC has approved a short term Enhanced Recovery Bridge Fund of $221,000  to boost or supplement a BC site’s current resources and strategies during this transition phase.

The SSC Enhanced Recovery Bridge Fund, to be used by March 31, 2017, aims to help:

  1. Maintain the Enhanced Recovery infrastructures already in place;
  2. Support the launch of Enhanced Recovery in new sites and service lines; and
  3. Keep momentum going while conversations about a provincial approach to Enhanced Recovery take place.

The Enhanced Recovery Fund was met with an overwhelming response from interested sites. The SSC is pleased to announce that it has approved funding for 22 hospitals from across BC. Funds will support activities not only in elective colorectal surgery – where most sites start their Enhanced Recovery programs – but also emergency general surgery, hepatobiliary, gynecology, and urology procedures. New pathways and accompanying tools across all sites will be shared on this website as they become available.

Congratulations to the Fund Recipients:

 

 

FRASER HEALTH ISLAND HEALTH
Abbotsford Regional Hospital Campbell River Hospital
Burnaby Hospital Cowichan District Hospital
Chilliwack General Hospital Victoria General Hospital
Delta Hospital NORTHERN HEALTH
Eagle Ridge Hospital Mills Memorial Hospital
Langley Memorial Hospital University Hospital of Northern BC
Peace Arch Hospital PROVIDENCE HEALTH CARE
Ridge-Meadows Hospital St. Paul’s Hospital
Surrey Memorial Hospital VANCOUVER COASTAL HEALTH
Royal Columbian Hospital Lions Gate Hospital
INTERIOR HEALTH Richmond Hospital
Kelowna General Hospital Vancouver General Hospital
Penticton Regional Hospital
Royal Inland Hospital

 

 

Tools: Updated Enhanced Recovery Nursing Tool from Royal Inland Hospital

Thank you to Royal Inland Hospital for sharing their updated Enhanced Recovery Nursing Tool. This sheet is included in a binder that sits at the bedside and provides a guide to staff caring for Enhanced Recovery patients. The tool has been updated so that it now provides guidance for caring for all Enhanced Recovery patients, not just colorectal patients.

Download the document from here or go to the Staff Resources option under the Tools tab, where you’ll find even more resources.

If you apply any of the documents found on this website to your own settings, please acknowledge the organization that originated the documents in your own versions. If you have resources to share, please send them to us!

Download (RIH-Nursing-Tool-June-1-2016.pdf, PDF, 47KB)

Tools: Fraser Health’s Updated Patient Resources

Thank you to Fraser Health for sharing their updated Enhanced Recovery patient resources. You will find updated versions of the ‘Preparing for Surgery – Quick Reference Checklist’ and the ‘My Daily Goals After Surgery’ worksheet. Download the documents from here or go to the Patient Education option under the Tools tab.

If you apply any of the documents found on this website to your own settings, please acknowledge the organization that originated the documents in your own versions. If you have resources to share, please contact us!

Download (FHA-preparing-for-surgery-checklist-176447_Aug-2016.pdf, PDF, 219KB)

Download (FHA-my-daily-goals-after-surgery-176448_Aug-2016.pdf, PDF, 481KB)

Enhanced Recovery Collaborative Final Reports

The Enhanced Recovery Collaborative has produced two final reports.

The first is a comprehensive Final Report that details the background on the Collaborative, the qualitative and quantitative results, the resources that were shared and developed, and lessons learned about site-level implementation of an Enhanced Recovery program, as well as the implementation of a provincial, quality improvement initiative. We hope this full report serves as a helpful reference for individuals and teams that are tasked with the implementation of Enhanced Recovery at single or multiple sites.

We have also produced a Highlights version of the Final Report, which is a shorter report that summarizes the background, results, available resources (tools and templates), and a high level description of lessons learned.

To access the reports, click on the links above or check out the Change Management page for these and other resources.

 

Tools: New Clinical Guidance Notes

The Anesthesia Community of Practice* and Nutrition Community of Practice are pleased to distribute three new clinical guidance documents on pre-operative carbohydrate-loading, goal-directed fluid therapy, and opioid-sparing technique. These documents can be downloaded below or accessed on the Guidance Notes Page along with other resources.

These Clinical Guidance Notes were developed by the respective Communities of Practice of the BC Enhanced Recovery Collaborative. They have been reviewed by the multi-disciplinary members of the Collaborative, presented to the BC Anesthesiologists Society for feedback, and approved by the Collaborative’s clinical co-chairs.

These documents are not intended to serve as a comprehensive review of the literature, or a statistically driven guidelines document. Each COP undertook an extensive review of current literature and practice patterns, assessed the practical implications of the various proposed algorithms, and sought to summarize evidence and advise British Columbia’s clinicians as to best practice based on current evidence. In the end, each site and practitioner should base decisions on providing patient care based on consultation with local care providers, and through a multidisciplinary collaborative approach.

Many thanks to the members of the Communities of Practice (membership listed in the documents) and the lead authors of these documents: Kaley Berg, Dr. Ron Collins, Dr. Mark Masterson, Dr. Kelly Mayson,  and Dr. Jill Osborn.

Download (Pre-Op-CHO-Loading-Guidance_FINAL-FOR-DISTRIBUTION_20160610.pdf, PDF, 181KB)

Download (GDFT-guidance_FINAL-FOR-DISTRIBUTION_20160610.pdf, PDF, 295KB)

Download (Opioid-Sparing-guidance-note_FINAL-FOR-DISTRIBUTION_20160610.pdf, PDF, 171KB)

 

*The provincial Enhanced Recovery Collaborative includes a Community of Practice (COP) for each of surgery, anesthesia, and nursing/administration. For areas of the Enhanced Recovery protocol where a strong recommendation does not appear in the literature and where clearer guidance would facilitate Enhanced Recovery implementation, the COPs provide an opportunity for a working group of practitioners to come together with the aim of developing stronger guidance. COP participation is open to all disciplines.

Tools: PHC Lidocaine Infusion (IV) Low Dose Protocol

Thank you to Providence Health Care for sharing their protocol for lidocaine infusion (IV) low dose for neuropathic pain or post-operative pain management. Download from here or go to the Staff Training option under the Tools tab to access this and other resources.

If you apply any of the documents found on this website to your own settings, please acknowledge the organization that originated the documents in your own versions. If you have resources to share, please contact us!

Download (PHC-Nursing-Care-Stds_lidocaine-low-dose-iv-protocol-for-post-op-and-neuropathic-pain.pdf, PDF, 141KB)

 

Tools: Updated colorectal order sets and patient information, RIH

Thank you to Royal Inland Hospital for sharing their updated Enhanced Recovery pre-op and post-op order sets, as well as their pre-op instructions for patients for colorectal surgery. Download from here or go to Orders Sets option under the Tools tab to access these and other resources.

If you apply any of the documents found on this website to your own settings, please acknowledge the organization that originated the documents in your own versions.

Download (General-Surgery-Pre-op-orders_RIH_2015-03-12.pdf, PDF, 129KB)

Download (Colorectal-Surgery-Post-op-orders_RIH_2016-02-19.pdf, PDF, 121KB)