Promoting Interprofessional Collaboration by Developing an Enhanced Recovery After Surgery Program in Surgical Oncology

Enhanced recovery after surgery (ERAS) is an evidence based perioperative protocol that has been successfully introduced into several surgical disciplines over the last decade. The ERAS protocol addresses the following phases of patient care: preadmission, preoperative, intraoperative, and postoperative. A multidisciplinary care team is required to address the complex health care needs of patients recovering from oncologic surgical procedures. A patient centered approach is also key to ensure patients have timely access to the health care resources and information they need to successful recovery from treatment. The key elements of ERAS focus on the following: comprehensive patient education, preservation of gastrointestinal function, reduction in organ dysfunction, active pain management, and early ambulation. Cytoreduction (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has been effectively used to treat patients diagnosed with advanced abdominal cancers. Patients diagnosed with primary tumors originated in the appendix, colon, ovary, stomach, and pancreas have been treated with HIPEC at this academic center. Careful patient selection and staging of disease is important to ensure patients will actually benefit from the HIPEC procedure. This surgical procedure is often associated with a prolonged recovery period and increased risk for hospital readmission due to postoperative complications. An interprofessional team worked together to develop a comprehensive perioperative ERAS protocol for patient undergoing CRS and HIPEC at an academic center. A clinical pathway, electronic orders sets, education booklets, and education videos were developed as a result of this protocol. This development process was completed after nearly two years of ongoing collaboration of the various disciplines involved in patient care and culminated with the final approvals from the internal review committees within the healthcare organization. Patients preparing for this advanced surgical procedure will now have access to a comprehensive educational experience and support team to better prepare them for the challenges of recovering from CRS and HIPEC.