The Future of Surgical Recovery, Thanks to You

The ERAS program is transforming the way patients heal. Thanks to your generous support, every day on the Enhanced Recovery After Surgery (ERAS) unit at the Montreal General Hospital (MGH-MUHC), a multidisciplinary team is united by a mission and philosophy of care: to improve patient recovery.

“Everyone who works on this unit, from PABs to LPNs and nurses, shares the same goal,” explains Paule Jubinville, RN, Nurse Manager of the nine-bed ERAS unit at the MGH-MUHC. “We follow the ERAS principles, such as reinforcing early mobilization, encouraging patients to eat as early as possible, pain control, and more. We all work together to promote the patient’s return home, involving family members every step of the way.”

Indeed, imagine if instead of a lengthy hospital stay, your loved one’s operation involved a proven multidisciplinary pathway for care before, during, and after the procedure – to ensure optimal recovery?

This transformative concept is at the heart of ERAS, an internationally practiced approach involving surgeons, nurses, anesthesiologists, medical consultants, nutritionists, physical therapists, social workers, and psychologists. Each surgical guideline – called a pathway – is a detailed, step-by-step plan for optimal trajectory of care, from the patient’s initial visit with the surgeon to their recovery.

A World Leader in ERAS Success

Thanks to your generosity, the Montreal General Hospital Foundation (MGHF) has enabled the MGH-MUHC to become a world leader in implementing ERAS protocols, including opening one of Quebec’s first in-patient units dedicated to ERAS and improving patient recovery.

In addition to our ongoing funding of ERAS at the MGH, the Foundation’s philanthropic support has been essential to establishing the provincial program (known as RAAC – La récupération améliorée après la chirurgie). We funded equipment to help collect data, among other support.

In Quebec, about 88 hospitals are implementing ERAS pathways.

“Because of our success in implementing ERAS, the MUHC has been contracted to develop the data audit and feedback dashboards to support uptake of this approach throughout Quebec,” says MUHC Surgeon-in-Chief Dr. Liane Feldman, who leads the MGH-MUHC’s ERAS program as part of her transformative Future of Surgery initiative – thanks to you!

Dr. Feldman notes that since the ERAS unit opened at the MGH-MUHC, the percentage of surgeries cancelled because no bed was available has decreased from seven percent to just one percent. Data also shows that ERAS has resulted in a significant reduction in the average duration of hospital stays, and in reduced complications.

Multidisciplinary Pathways for Optimal Recovery

While the ERAS unit at the MGH-MUHC opened in 2023, Dr. Feldman and her team have been developing and applying ERAS into their surgical procedures since 2008.

Debbie Watson, RN, has been part of the project from the start. She now has two ERAS jobs: She’s a Surgical Care Pathway Coordinator at the MGH-MUHC, and in 2022, she also brought her expertise to the provincial ERAS program (now under Santé Québec) as its Clinical Care Coordinator.

“I love breaking down silos and working together around the table with a multidisciplinary team,” says Ms. Watson – who is passionate about health literacy – about developing new surgical pathways alongside medical leaders and expert consultants. “When we launch a new pathway and create information booklets for patients, hearing patients’ comments is extremely gratifying.”

In layman’s terms, ERAS pathways can be described as optimized best practices for specific surgical procedures from pre-op to post-op, including education, exercise, nutrition, pain management, medication orders, and more – to get patients back to normal life. Each kind of operation has its own specific pathway.

Currently, Dr. Feldman’s team has unique pathways in place for more than 35 kinds of surgeries. These pathways are constantly evolving thanks to ongoing data review (including indicators of process and results), improvements in surgical techniques or medication protocols, and clinical feedback, among other factors.

Clinical Feedback to Benefit Patients

“When Surgical Care Pathway Coordinators update or create a pathway, they want the clinical feedback of many people,” Ms. Jubinville explains. “So, we’re part of that process, since we’re the ones actually seeing the application of the pathway post-op, seeing those patients and working with the medical teams. The assistant nurse manager of the unit and other members of our team can give their feedback.”

While quick recovery is generally encouraged in most surgical contexts, in the ERAS unit, these protocols are ingrained into the way they care for patients, says Ms. Jubinville. “What’s different on the unit is really the promotion of those ERAS pathways and principles. Patients arrive already informed and should know everything that needs to be done, and we reinforce it.” She adds that if patients follow the pathways, for some operations (such as bariatric and maxillofacial surgeries, for example) “they can be in and out in 24 hours.”

ERAS Helps Transform Healthcare

Ms. Watson explains that the provincial ERAS program began in 2022. “When COVID happened, thousands of hip and knee arthroplasty surgeries got delayed. We, at the MGH, had already started a day surgery program in hip and knee; now it’s province wide. When I started working with the provincial ERAS program in 2022, approximately 20 percent of Quebec’s hip and knee arthroplasty were day surgeries, where patients go home on the same day. And now, we’re close to 50 percent.” Of course, “safety is always number one,” so inclusion and exclusion criteria are in place to identify patients who can be operated on and go home on the same day of their surgery.

Certainly, evidence shows that ERAS can benefit both patients and the healthcare system. The program aims to take social responsibility to heart, placing the patient and their families at the centre of care and striving to adapt to different populations, barriers, and inequalities. More specifically, its success has freed up hospital beds and resulted in less surgery cancellations, creating a wave of meaningful impact. By freeing up beds, patients spend less time in crowded ERs and can be admitted to floors more swiftly, improving the flow within the entire hospital.

Your philanthropic support makes all this possible! “Thanks to our program’s leaders and hard-working teams in the unit, ERAS is improving the outcomes and experiences of surgical patients,” Dr. Feldman says. “We couldn’t be more pleased to see the impact the pathways we’ve developed are having on patients, families, and our healthcare system, and look forward to seeing this transformative approach continue to shape the future of surgery. Thank you for your support.”

Let’s transform healthcare together.

Thank you for your generosity!