Personal Perspective: Why does Canadian healthcare need the Enhanced Recovery Society of Canada? by Dr. Ron Collins

“Personal Perspectives” provide a space for practitioners to offer their personal views about any aspect of enhanced recovery. “Personal Perspectives” do not necessarily reflect the views of the ERAS Collaborative in general. If you would like to contribute your personal perspective, please contact the Project Manager. Read on for our first personal entry by Dr. Ron Collins.

Why does Canadian healthcare need the Enhanced Recovery Society of Canada?

(an excerpt from the Enhanced Recovery Society of Canada website, which will go live soon,

By Dr. Ron Collins, ERAS Collaborative Anesthesia Co-Chair; Executive Medical Director, Quality & Patient Safety – Interior Health; Staff Anesthesiologist – Kelowna General Hospital.

There are reasons to believe that the Canadian health care system is facing huge challenges.  In fact, some projections suggest that in its present form, the Canadian health care system is approaching an unsustainable state.  This is clearly unacceptable to our vision of Canada as a society, to Canadians who need access to care and to those who function as stewards of Canadian health care, trying to direct its course.

The potential failure of Canada’s health care system is personally unacceptable to me because I have three children who, while early in their journey of life, will someday likely interact with the health care system, and it is part of my personal vision to ensure that, when they need it, the health care system meets their needs in terms of care and compassion as well as access, quality and reliability.

Given that context, then, what is Enhanced Recovery, and what does it promise to Canadian health care?  Enhanced Recovery applies to many groups of surgical patients.  Enhanced Recovery is a series of sets of evidence-based, consensus driven recommendations that require implementation by multi-disciplinary teams of frontline clinicians.  Enhanced Recovery considers the entire patient journey from the decision to operate until several weeks after returning home from hospital.  Enhanced Recovery recommends a series of individual processes of care that must be carefully and thoroughly applied; the more processes of care adhered to, the better the outcomes that result.  Several of these recommended processes of care represent significant departures from traditional approaches to surgical care.  Enhanced Recovery must be multidisciplinary because the care processes used by each member of the patient’s care team has direct impacts on the rest of the team; all these processes of care must be considered together.  While we refer to Enhanced Recovery as a ‘pathway’, it is more of a collaboration and a conversation that considers the question: “For this patient, with their particular issues and desires, having this particular procedure, with the resources available to this particular team: how are we going to provide the best possible care with the lowest possible chance of complications?”

The promise of Enhanced Recovery is best expressed as an opportunity to prevent complications; it makes a patient’s journey back to good health faster and easier.  Patients recover their pre-operative functional status in terms of diet and activity sooner and are able to complete their recuperation at home much sooner than in the absence of Enhanced Recovery.  Patients having colorectal surgery for instance suffer 50% fewer complications when Enhanced Recovery processes of care are applied.  We all recognize that complications are major drivers of human suffering, length of stay and the cost of providing care.  Complications have lasting effects; we know that patients who suffer complications are more likely to require additional episodes of care, and we know their life expectancy decreases.  These lasting effects are apparent for 8 years after the complication.

The most compelling lesson that Enhanced Recovery has taught me relates to the consistently observed reduction in complications.  It is typical for surgeons and anesthesiologists to assume that complications are ‘part of the cost of doing business’; things don’t always go according to plan.  Enhanced Recovery challenges that assumption; it is clear that at least 50% of complications, and perhaps more, can be prevented by addressing the processes of care that, when added together, define the patient’s surgical journey.

So, Canadian health care needs the Enhanced Recovery Society of Canada because the society promotes the development and implementation of processes of care that reduce complications and the human suffering that accompanies them, because it reduces the resources required to provide care, because there are still many opportunities across the country to improve on traditional approaches to care and because, as we implement these new processes of care, we are still learning what further improvements are possible.  The Society is a common resource for everyone who wants to participate in this exciting opportunity to lead, to learn and to contribute to a new vision for safer surgical care in Canada.

The Specialist Services Committee, a partnership of the Doctors of BC and the BC Ministry of Health, is a leading example of how engaging in this initiative can bring results.   The SSC has supported the development of a multi-disciplinary provincial Enhanced Recovery Collaborative that is now implementing enhanced recovery principles in all the geographical health authorities in British Columbia.  Surgeons, anesthesiologists, nurses, and allied health professionals are working together in a mutually beneficial way to see that the best possible outcomes can be achieved for patients.

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