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torrancememorial.org PULSE | 33 H E A RT B E AT S T orrance Memorial Medical Center anesthesiologist Mark Ancheta, MD, is hoping to transform how patients are cared for before, during and aer surgery. Doctor's orders in the past have called for fasting aer midnight the night before and restricting physical movement immediately aer surgery. But an evidence-based approach to surgical care called Enhanced Recovery Aer Surgery (ERAS) is changing long-standing surgery practices. "It's a par- adigm shi from the way we have been taking care of surgery patients for decades," says Dr. Ancheta, who is championing implementation of the ERAS protocol here. e goal of ERAS is to get patients back to their normal selves as quickly as possible aer surgery. And the patient plays an active role in that aim, beginning with how they prepare for surgery. "Patients should speak with their primary care physician about ways to optimize their health before the operation—for example not smoking a month before surgery, lim- iting alcohol and making sure to exercise," Dr. An- cheta advises. With the ERAS protocol, patients are also al- lowed to eat up to eight hours before their sched- uled surgery time and drink a complex carbohydrate liquid recommended by their doctor three hours before, making for a happier patient who is not starving prior to their surgery and who feels better in recovery. "Ideally by the time the patient gets to the hospital, they will have done all these things," Dr. Ancheta says. ERAS is also in place during the operation, with the anesthesiologist limiting intravenous fluids and removing unnecessary drains to decrease the risk of infection. Aerward pain is controlled with an epi- dural, nerve block, non-narcotics and/or low-dose narcotics. Patients are encouraged to sit up and walk within hours. "Gone are the days of bed rest aer surgery. You have to be active if you want to get out of the hospi- tal faster," says Dr. Ancheta. ERAS has been in place in Europe for more than 15 years. It was first used with colorectal surgery but is becoming more common with g ynecological oncolog y, bariatric surgery, cystectomies and the Whipple procedure for pancreatic cancer. In the past five years hospitals in the United States have be- gun to follow suit—Duke University Hospital and Mayo Clinic were among the first to pioneer it. Studies have shown that ERAS shortens the patient's time in the hospital, decreases the risk of complications and increases patient satisfaction because they're back to their normal productivity more quickly. Hospitals have seen reduced costs and no in- crease in readmission. ERAS was officially implemented at Torrance Memorial in the fall by Dr. Ancheta and his team. ey are currently collecting patient satisfaction and other data to demonstrate program success here. He worked with Deb Butler, RN, director of perioperative services, for three years to get the ERAS protocol in place. ey formed a mul- tidisciplinary committee composed of dietitians, nurses, surgeons and anesthesiologists to ensure seamless integration. "We wanted to get as many departments in- volved as possible because ERAS involves the entire continuum of surgical care," he says. Collaboration and communication are critical because ERAS measures need buy-in from all peri- operative team members in order to be effective for the patient and for the hospital. Patient education is also essential. But transitions are not always easy, Dr. Ancheta acknowledges. "is is a cultural and mental shi that challeng- es years of surgical doctrine, but it's very exciting at the same time." Dr. Ancheta has been on staff at Torrance Memorial for 11 years and says he especially ap- preciates the collegial environment and the strong relationships with surgeons and the nursing staff. He's also proud to lead the charge in changing the traditional way the hospital approaches care for its surgical patients. "Hopefully we're making a positive difference in terms of earlier hospital discharge, less postoperative surgical complications and improved patient well- being," Dr. Ancheta says. "Torrance Memorial is a progressive hospital, and we're always looking ahead. So ERAS shouldn't be something we wait to do in the future. "e future is here. And it is the best thing for the patient."