Cardiac Surgery ERAS Guidelines
Airway Breathing Coffee teamed up with Dr. Clunie and her team to create infographics about the Cardiac ERAS guidelines before, during and after surgery. Please read below for more information around the Cardiac ERAS Knowledge Translation and Implementation in Saskatchewan Project that is ongoing.
We also encourage you to watch the videos for Cardiac ERAS for Healthcare Workers and Patients by clicking on the links below.
Cardiac Enhanced Recovery After Surgery (ERAS) Knowledge Translation & Implementation in Saskatchewan
Enhanced Recovery After Surgery (ERAS) is a multimodal patient-centered approach to providing care before, during, and after surgery. Incorporating ERAS best practice recommendations can significantly benefit patients, healthcare providers, and system resources.1,2,3 The overarching goal of this project was to encourage the adoption of Enhanced Recovery After Cardiac Surgery (Cardiac ERAS) best practice recommendations4 to improve the access, experience, and outcomes for cardiac surgical patients in Saskatchewan through knowledge sharing.
Our multidisciplinary team of cardiac surgery stakeholders selected six ERAS Recommendations to prioritize for knowledge translation (KT) and implementation in Saskatchewan: 1) multimodal opioid-sparing analgesia, 2) prehabilitation, 3) early prioritized mobilization, 4) extubation within six hours, 5) goal-directed fluid therapy utilizing available measures of fluid responsiveness to achieve target MAP, and 6) patient & family engagement.
Following ethics approval (REB #2831, 24 August 2021), we deployed a targeted educational campaign for patients, healthcare providers, and decision makers in the Saskatchewan Health Authority about the evidence-based Cardiac ERAS recommendations. We developed and delivered a series of knowledge translation tools tailored for each of our stakeholder groups, including: 1) multidisciplinary Grand Rounds and nursing education day presentations; 2) animated videos for both patients and their families5 and healthcare workers;6 3) online platform to host Cardiac ERAS KT tools and resources. www.HeartSK.ca
Our team continues to build upon these knowledge translation activities with an implementation-effectiveness study. Cardiac surgery ERAS order sets, learning modules for healthcare providers, and patient posters and pamphlets have been developed. The goal is to begin formal Cardiac ERAS implementation on April 1, 2023.
We are fortunate to have four Anesthesiology Residents involved in the knowledge sharing and implementation project! Dr. Anne-Marie Friesen’s resident research project will evaluate the impact of cardiac ERAS implementation and educational materials on patient-reported outcomes, engagement, and experiences. Dr. Gemma Percival’s project is an audit of Goal Directed Therapy and Albumin utilization and the impact on cardiac surgical patient outcomes. Dr. Kim Mayville has developed a hemoglobin optimization protocol for early detection, diagnosis, and treatment of anemia in cardiac surgery patients and will evaluate this prehabilitation strategy’s impact on patient outcomes.
The Knowledge Translation Project was supported by a Saskatchewan Health Research Foundations (SHRF) Connections Grant and the Provincial Department of Anesthesiology Research Engagement (DARE) funding. The Cardiac ERAS Implementation Study is made possible with a USask CoMRAD Award. Thank you to Dr. Alixe Pellerin and Dr. Lei Xia for their expertise and help in creating KT tools and these awesome posters!
References
1. Al-Omary MS, Williams T, Brienesse SC, et al. Impact of Delay in Surgery on Outcome in Patients Undergoing Cardiac Revascularisation Surgery. Hear Lung Circ. 2021;30(6):888-895. doi:10.1016/j.hlc.2020.09.935
2. Gregory AJ, Grant MC, Boyle E, et al. Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes. J Cardiothorac Vasc Anesth. 2020;34(12):3218-3224. doi:10.1053/j.jvca.2020.08.007
3. Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg. 2020;159(4):1393-1402.e7. doi:10.1016/j.jtcvs.2019.05.035
4. Salenger R, Morton-Bailey V, Grant M, Gregory A, Williams JB, Engelman DT. Cardiac Enhanced Recovery After Surgery: A Guide to Team Building and Successful Implementation. Semin Thorac Cardiovasc Surg. 2020;32(2):187-196. doi:10.1053/j.semtcvs.2020.02.029
5. Cardiac Enhanced Recovery After Surgery (ERAS) for Patients | Saskatchewan Cardiac ERAS – YouTube. Accessed December 20, 2022. https://www.youtube.com/watch?v=IdjebzaPbgo
6. Cardiac Enhanced Recovery After Surgery (ERAS) for Healthcare Workers | Saskatchewan Cardiac ERAS – YouTube. Accessed December 20, 2022. https://www.youtube.com/watch?v=A9HGSCB990M
7. Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for implementing change: A psychometric assessment of a new measure. Implement Sci. 2014;9(1):1-15. doi:10.1186/1748-5908-9-7
