At 5-Year Mark, ERAS Program Improving Outcomes for Surgical Patients

Tori Leyba, of Glenville, doesn’t shy away from talking about her recent history of health problems. The 29-year-old personal trainer and former military member was in good health through her 20s. Something changed in 2016, when she started to feel the impact of what would later be diagnosed as ulcerative colitis.

Medications and treatments initially had a positive result, but by 2018 her health was deteriorating. Pain, difficulty eating, and incontinence were a part of everyday life and she struggled to find answers.

By April of 2020, following multiple doctor visits and hospital stays, Leyba was brought to Albany Medical Center, where she had an ostomy procedure that improved her health but also made a permanent change to the way she lives.

“The idea of having an ostomy bag placed on my stomach was definitely life-changing and traumatic,” Leyba said.

Leyba underwent an emergency procedure and spent about a month in the hospital. During her first stay at Albany Medical Center, Leyba met with multiple members of the Enhanced Recovery After Surgery, or ERAS, program. ERAS is a patient-centered model that coordinates a patient’s care from the time a decision is made to undergo surgery, through discharge and follow-up appointments.

Improving Outcomes and Patient Satisfaction

The ERAS model was pioneered at Albany Medical Center in 2016 with the goal of improving overall patient experience and outcomes. Two members of the Department of Anesthesiology, Divya Cherukupalli, MD, and Igor Galay, MD, collaborated with surgical teams, seeking to optimize patient health prior to surgery, manage post-operative pain using innovative and evidence-based practices, and ensure that a patient returns to normal activities as soon as possible.

“We use current evidence to bring about improved outcomes and increase patient satisfaction,” said Dr. Cherukupalli, who serves as director of the program. She is part of a multidisciplinary team that includes anesthesiologists, nurse practitioners, registered nurses and anesthesiology residents.

Once a decision is made to proceed with surgery, a patient meets with an ERAS navigator who educates and counsels about the surgical process, details goals and expectations, and assesses their overall health to put them on a path to surgical success. A patient in the ERAS program meets with multiple members of the team on the day of surgery and following the procedure.

ERAS Navigator Jo Brice, RN, credits the nurse practitioners for playing a crucial role.

“The support, care and advocacy that our nurse practitioners show our patients is integral to their recovery, safety, and overall patient experience,” Brice said. She notes that ERAS nurse practitioners will often round multiple times per day, coordinating care with surgical teams and identifying clinical interventions to assist patients with recovery while managing their pain.

ERAS Aids in Recovery Time

Months after Leyba’s first procedure helped her bring a serious medical condition under control, she returned to Albany Medical Center in September of 2020 for a scheduled procedure that was the next step in ensuring her long-term good health.

Leyba again met with Jo Brice, who was with her every step of the way.

“Jo was the one I had primary contact with,” Leyba said. “On the day of my surgery, she was at my bedside. If I was in pain, she would help me to find ways other than pain medications to get through that.”

Leyba says the ERAS program also provided her with nutritional support and education that made her 10-day stay at the hospital better than she could have imagined.

“Without the ERAS program, I would have had a much harder time recovering,” Leyba said. “Because of ERAS, I had a team working with me closely to guide me through the process.”

The ERAS team’s work has led to improved patient satisfaction, decreased complications and reduced lengths of hospital stay across many surgical specialties, including colorectal, urology and oncology. It’s an exciting evolution of the program for those who were there at its start five years ago. Since the program’s implementation, statistics show decreases in cardiac complications, hospital readmissions, pneumonia, blood clots, infection, and even mortality rates of surgical patients.

“We started ERAS focusing on colorectal procedures on a trial basis,” Dr. Cherukupalli says. “In that time, we found that the ERAS practices decreased the use of opioids and positively impacted a patient’s outcome.”

The ERAS team uses nerve blocks and a combination of oral and intravenous medications for pain control to minimize use of opioid-based medications. This helps to avoid the negative side effects of opioids, and the dangers associated with their potential misuse.

One of the first surgeons to jump on board with implementing ERAS practices for surgical patients was Brian Valerian, MD.

“The collaborative piece of it is what makes it work,” Dr. Valerian says. “There’s support from nursing staff at all levels. It’s just an entire way of thinking about what we are doing for the patient.”

Changing the Patient Experience for the Better

Led by their mission to improve the patient experience, there is a world of possibility for how far the program can go to support patients.

“ERAS isn’t just about incorporating multimodal pain management into the care plan, or getting the patient out of bed sooner,” said Stephanie Jones, MD, chair of the Department of Anesthesiology.

“It’s a process that changes the entire experience to benefit the patient.”

And for surgeons like Dr. Valerian, it’s clear to see the benefits for their patients.

“This started out as a novel thing, as more of a project,” Dr. Valerian says. “And now, it is the standard of care.”