By Jeanna Hofmeister
Imagine having your morning cup of coffee just two hours before major surgery. Envision waking up in recovery and then enjoying a full meal only a few hours later. Picture your postoperative pain being well managed with over-the-counter remedies. Better yet, see yourself going home healthier in one-third of the time you expected. If that scenario sounds radically different than what you anticipated or has previously experienced, it is. This is the new Enhanced Recovery Program at Kootenai Health.
“The Enhanced Recovery Program is a revolutionary paradigm shift in the care of surgical patients,” said Kootenai Health surgeon Marcus Torgenson, M.D. “Moving to this kind of protocol means patients get better care, shorter hospital stays and overall, recover better with less pain.”
The movement toward this new kind of pre- and post-surgical protocol began in Europe but is rapidly gaining traction across the United States. Dr. Torgenson was charged with leading the effort to implement enhanced recovery at Kootenai Health. Last September, he and his team met with peers at Mayo Clinic to learn more about the program’s protocols and benefits.
“It’s a brand-new concept for health care,” he said. And it’s just one of many benefits made possible through Kootenai Health’s affiliation with Mayo Clinic. “Our level of care has increased significantly through our partnership. It is such a great resource to be a part of the Mayo Clinic Care Network. Without them, we wouldn’t have been able to do this as efficiently.”
A few weeks later, Dr. Torgenson dove deeper into the enhanced recovery concept with peers from Duke, Cleveland Clinic and the MD Anderson Cancer Center at the American College of Surgeons Clinical Congress. In early October, after research and fact-finding, he presented the Enhanced Recovery Program model to the various groups of health care providers within Kootenai Health.
He says support for the change was overwhelming. By mid-October, his department began to implement the new protocol with patients.
“When you’re introducing, basically a new pathway, there are usually providers who are skeptical or hesitant to change their practice, but that simply was not an issue for us.” While Dr. Torgenson led the charge to put the plan into action, he said it’s been a real team effort. “The enthusiasm for a change like this, from the entire Kootenai Health staff, makes me really proud of where I work.”
Some have likened the change in protocol to training for a marathon. Instead of starvation and dehydration prior to their procedure, patients are encouraged to quit smoking, exercise more, hydrate well and load up on nutritious carbs. Post-op, with the help of hospital staff, they are up and
moving on day one. They’re also eating and drinking plenty of fluids, essential to the healing process, as well as limiting narcotic pain medications. Faster recovery means fewer meds and a shorter stay in the hospital.
The difference in post-operative results is nothing short of spectacular.
“Patients who would have previously spent five to seven days in the hospital following surgery now go home in two or three.” According to Dr. Torgenson, “It’s a win-win, across the board.”
While enhanced recovery patients benefit from a health perspective, the new program makes a difference to their bottom line as well.
“Cost is never the motive for introducing a program like this, so I hope you’ll mention it last,” Dr. Torgenson laughed. “But it’s true. Patients do incur lower expenses because of their shorter hospital stay. I’m just really happy to be doing something to dramatically improve patient care, and it’s really satisfying to know that we’re improving care across the organization.”
At Kootenai Health, the new protocol is limited to colorectal surgery and urology procedures for now, but the program is geared to spread rapidly throughout all the hospital’s surgical disciplines in the next year. While it may be too early to speculate on the long-term effects of enhanced recovery, the program’s future looks promising.
To date, despite having a decreased length of stay, staff are happy to see there has been no increase in 30-day readmission rates due to complications for enhanced recovery patients, Dr. Torgenson said. “I think the best results may be yet to come.”
Find out what your best options are at Kootenai Health. Call (208) 625-4000.
Photo: Kootenai Health staff visit Mayo Clinic to learn about the Enhanced Recovery Program. From left: Fran deTar, R.N.; Tina Rieken, R.N.; Marcus Torgenson, M.D.; Zach Lorenz, R.N.; and Mark Harrel, C.R.N.A.