Enhanced Recovery After Surgery and Fecal Diversions: A Provincial Initiative to Standardize the Approach to Care for Patients Undergoing Colorectal Surgery

Enhanced Recovery After Surgery (ERAS) is a multimodal program developed to decrease postoperative complications, enhance recovery and promote early discharge.  In the province of Ontario, Canada, a standardized approach to the care of patients undergoing colorectal surgery was adopted by 15 hospitals across the province in March 2013.  All elective colorectal surgery patients with or without an ostomy were included in the ERAS program targeting a length of stay of 3 days for colon surgery and 4 days for rectal surgery.  It was important to ensure that the individual needs of patients requiring an ostomy were being met within this new health care delivery model given that ERAS was becoming the standard of care.  Different providers with varying levels of experience and expertise were caring for this vulnerable patient population and there was variation in the supports available and offered to patients following their acute care discharge.  To address this issue, a provincial ERAS Enterostomal Therapy Nurse (ETN)  Network was struck, with a goal to develop and publish an ostomy specific clinical practice guideline for ERAS patients requiring a fecal diversion. 

This presentation will provide participants with an overview of the work accomplished by this group over a 2 year period.  Evidence to date addressing ERAS specific to the patient requiring a fecal diversion will be highlighted.  In addition clinical recommendations developed by the ERAS ETN Network will be identified.  The recommendations will address the preoperative, postoperative and initial discharge period which will facilitate a standardized approach to the care of patients with an ostomy at the provincial level.