ERAS protocol

ERAS PROTOCOL

ERAS is acronym of ENHANCED RECOVERY AFTER SURGERY that is the BEST RECOVERY AFTER SURGERY

This is a protocol adopted for laparoscopic and robotic surgery, whose peculiarity is the patient’s active protagonism in pre- and postoperative phase. The aim of ERAS is a rapid post-surgical recovery through an optimal preoperative condition and early post-surgical mobilization and nutrition. Many post-surgical complications in colorectal surgery are indeed caused by a not optimal patient’s preoperative nutritional, physical and motor condition and immobility and long stay in hospital after surgery.

The patient is asked to keep a daily diary and is helped since May 2020 by App ICOLON, a free application downloadable on smartphone and tablet (operative systems iOS ed Android) that accompanies the patient undergoing colorectal surgery during surgery preparation phases and after surgery returning home.

The ERAS protocol consists of three phases:

• PRE-SURGICAL with indications for achieving an optimal nutritional, physical and motor level before operation
• POST-OPERATION HOSPITALIZATION
• HOME DISCHARGE

At IRCCS Ospedale Sacro Cuore Don Calabria the ERAS protocol is applied since 2018 for colorectal surgery and is the result of collaboration between General Surgery Department and multidisciplinary group composed of anesthetists, pharmacists, dieticians, physiatricians and physiotherapists.

APP ICOLON

The App ICOLON was designed by General Surgery Department in collaboration with multidisciplinary and multispecialist group which follows the implementation of ERAS protocol (anesthetists, pharmacists, dieticians, physiatricians and physiotherapists) born from the need to stimulate and follow actively and carefully the patient during all perioperative period.

This is the first and, at the moment, only one Italian experience of mobile App accompanying patient during pre- and postoperative phases alway putting him/her in direct contact with surgical staff. Similar projects for colorectal surgery were developed only from a few other centers worldwide: in Europe by UMC (University Medical Center) Surgery Department of Amsterdam, in USA by Mayo Clinic, Texas University, and by some Canadian hospitals (Mount Sinai Hospital, McGill University Health Center)

HOW IT WORKS

iColon is organized, in compliance with ERAS protocol phases gradually realized in General Surgery since October 2018, in three phases

• Preoperative phase
• Admission phase
• Return home after discharge phase

Each of these phases corresponds to a daily diary that the patient is invited to fill in sending a feedback to staff physicians who will follow the course of each patient on a dedicated digital platform.

The App will be downloaded by patient on his/her tablet or smartphone during access to Hospital for pre-admission and each patient is educated by medical and nursing staff to use the App.

ICOLON IN DIFFERENT PHASES

• Preoperative phase
  iColon reminds and stimulates the patient, also by informative contents and videos, to follow the nutritional, physical and motor optimization.
• Admission phase
  As from operation day iColon accompanies the patient educating him/her on pain detecting, nausea, vomit and fever, and stimulating in nutrition and early and correct motor recovery.
• Return home phase after discharge
  After discharge patients will fill in the daily diary reporting a series of observations indicative of their state of health that they were educated to acquire during admission.

iColon represents a digital companion putting patient at the center of perioperative course, underwent colorectal surgery, following and educating him/her in any surgery preparation and recovery phase.

Such App acquires even more value in COVID-19 period, allowing to reduce surgery patients’ accesses to Hospital, but permitting at the same time to follow daily such patients by a series of detections indicative of their state of health.