By Emily Azari (ft. left) with Dr. Elizabeth Wick
When you think of colorectal surgery, you might assume it requires a day of fasting and bowel prep, maybe heavy duty pain medication as you recover. And you’d probably imagine lying in your hospital bed for several days while nurses cared for you.
In fact, there have been significant changes in colorectal surgery over the last several years thanks to a multimodal approach called Enhanced Recovery after Surgery (ERAS). The goal? To help patients recover faster and with fewer complications. Of course, surgical teams have long wanted what’s best for their patients, but exact procedures varied by institution, provider, and even the day of the week. ERAS offers a standardized protocol that enables patients to:
Avoid prolonged fasting: Getting adequate fluids and nutrients help the body better handle the stress of surgery
Receive multimodal pain management: Using multiple pain control methods leads to better pain relief and avoids harsh side effects from opioids
Move sooner after surgery: Getting up to walk soon after surgery helps prevent blood clots and gets the bowel working more quickly
To be successful, ERAS involves a lot of collaboration between team members: the surgeon, anesthesia provider, nurses… and notably, the patient.
The patient as a partner
To understand the importance of engaging patients in ERAS, I spoke with Elizabeth Wick, MD, a colorectal surgeon at the University of California San Francisco and an expert in improving perioperative care (ft. left). One of the key takeaways from our conversation was that clarity and effective patient communication isn’t about “getting patients to follow through.” Rather, it’s about fostering a partnership with the patient. In other words, we’re not simply expecting you to do X, Y, and Z. We’re working with you to get your pain under control so you can more easily do those things.
Motivating someone is more complex than simply giving directions, even if they’re clear. To spur action, Dr. Wick emphasized that clinicians need to explain the “why” behind instructions.
For example, be clear that walking after surgery will help you recover faster. Or with preemptive pain medication, which patients are often confused about (“hang on… why would I want to take this when I’m not in pain?”), explain that continuous pain control actually works best.
Surgery is scary and overwhelming. Dr. Wick and her team accounted for this psychological backdrop when they improved their anesthesia education to increase the consent for epidurals (an important part of ERAS).
Previously, the anesthesiologist entered the scene on the day of surgery, where they quickly went over the patient’s options. This overwhelmed people, and they were declining the epidural – a resounding “no, thank you” to a needle in their back. Now, the anesthesia education happens before the day of surgery, and it’s complimented by the Emmi anesthesia program. This approach is easier for patients to digest, Dr. Wick says, and they saw a 60% increase in epidural use.
Try not to reinvent the wheel
When asked for advice about improving the clarity of ERAS education, Dr. Wick cautioned against the urge to start from scratch. Communicating clearly and providing technical information is hard – as we know at Emmi, addressing health literacy involves much more than aiming for a certain reading level in Microsoft Word. To that end, she recommends partnering with experts who already have this skill set and who can help ensure all patients are hearing the most relevant information in a consistent way.
Finally, Dr. Wick reminds us that patients are receptive to this information (even the fine points) and want to be engaged. So embrace it! Partnering with patients helps ensure they’re getting the clear, on-point information they need.
Pain management during recovery:
Movement during recovery:
Emily Azari is a senior healthcare writer at Emmi, where she sorts through heaps of complex medical information and translates it into language patients easily understand. She thinks it’s pretty fantastic that her job involves following health news, debating grammar, and best of all helping people manage their health. Follow Emily on Twitter: @emilyazari
Dr. Elizabeth Wick is colorectal surgeon and associate professor of surgery as UCSF. She has expertise in surgical quality improvement and has published widely in this area. She has developed successful improvement collaboratives both locally and nationally.
The 7th Annual Health Literacy Blog Series: Clarity is Power!
October is Health Literacy Month. This article is a preview from this year’s series, with new articles most weekdays in October. We'll investigate how design, patients’ experiences, medical art and animation, a clear prognosis, listenability, and approaches like Enhanced Recovery create clarity and empower people. With articles from patients like Dave deBronkart, Casey Quinlan, Danny van Leeuwen, physicians such as Elizabeth Wick, Erica Spatz, and Neelum Aggarwal, as well as researchers, designers, artists and writers.
Follow the action on Twitter via @GeriLynn & @EmmiSolutions. Or sign up to be notified when new articles post at: http://www.emmisolutions.com/blog.