This document provides information for students on clinical placements about Enhanced Recovery After Surgery (ERAS). It discusses how surgical patient management has changed, with shorter hospital stays and improved outcomes. It summarizes the key aspects of ERAS, including carefully preparing patients before surgery, minimizing risks during surgery, early mobilization after surgery, and careful pain and nutrition management. The goal is for students to better understand modern post-operative care and for improved communication between clinical teams to identify complications early.

1. ERAS
What students on clinical placements need to know
By Dr. Anna Jarchow-MacDonald
University of Edinburgh, 2020
CC BY-SA
Image from flickr.com: “Scalpel” by Sarah CC BY 2.0
https://www.flickr.com/photos/96526303@N00/3560381477

2. Learning objective
This is an open learning resource for students who spend time on a surgical
ward.
Management of surgical patients has changed a lot over the last decades.
This has improved patient outcomes.
But it can leave less opportunity for teaching students.
There are many useful resources available which aim at clinical teams and
management. All information on these slides are provided by the
ERAS®society This resource concentrates on providing useful information for
students.
I am a Medical Microbiologist and I am keen on supporting students and patients through creating
awareness and skills around ERAS, as infections are a common complication after surgery.

3. ERAS - what is in an acronyme?
ERAS = Enhanced Recovery After Surgery

4. How it used to be…
• Patients used to come in at
least one day before
planned surgeries
• They stayed for several days
to weeks even if there had
not been any complications
after surgery
Image from National Library of Scotland: OFFICIAL PHOTOGRAPHS TAKEN ON
THE BRITISH WESTERN FRONT IN FRANCE - SCENE IN A WARD OF SA HOSPITAL
by Ernest Brooks CC BY NC SA

5. ERAS – Background
Globally there is a need to improve recovery after surgery. We know
increasingly more about what works. A plan was developed to
implement this knowledge. Standardising care leads to better
outcomes.
It was found to be possible to shorten patients’ stay in hospital. This
leads to a better experience for patients and to an improved patient
flow.
Communication is key to pro-actively identify complications.
Patients and all members of their care team are engaged in decision
making.

6. ERAS – Before and during operations
Surgical teams – surgeons, nurses, anesthetists, physiotherapists,
dieticians and more – undertake many steps to carefully prepare
patients for surgery. This includes choosing an appropriate care
pathway, identifying underlying health issues and addressing
expectations of the patient.
During surgery procedures and protocols are chosen to minimize the
risk of complications arising. This includes appropriate prophylactic
antibiotics, avoiding hypothermia and balancing fluids during the
procedure.

7. ERAS – POST-OP IN RECOVERY/ ON THE
WARD
Patients are mobilised early to avoid post-OP
complications.
Post-OP pain is managed carefully and opioid
analgesics are avoided where possible.
Appropriate nutrition is provided within 12 hours
after surgery.
Patients’ expectations and concerns are actively
listened to.
Image from flickr.com: “Health” by eoipso CC BY-NC 2.0

8. ERAS – POST-OP IN THE COMMUNITY
• GPs and practice nurses are often the first point of call for patients with an
infection. They need to get all information relevant to the immediate care
of the patient at the same time as patients are discharged.
• They need to be aware who to contact in the hospital if any concerns arise.
• Patients are issued with a clear care plan and safety netting information.
• They receive follow-up phone calls to support communication and to pick
up on complications early.

9. ERAS – Post-OP Infections
• Diagnosis
• Wounds need to be checked regularly –liaise with the nurse when changing the dressing unless it
has a clear window integrated
• Discharge ≠ always infection
• Cellulitis and pus from a wound are strong signs of an infection
• Consider appropriate imaging
• Repeat bloods if systemically unwell/ Review with experienced colleague if uncertain
• Samples
• If superficial infection only – pus in blunt syringe, otherwise wound swab
• If deep infection suspected – as above and blood cultures
• Management
• start empirical sepsis management if indicated!
• Discuss with seniors if surgical interventions are required
• Review with Tissue Viability team if soft-tissue infection
• Give antibiotics according to local protocol and clinical severity of the infection

10. ERAS – Summary
This open educational resource aimed at improving students
understanding of ERAS.
In the short term this is hoped to improve the students’ learning
experience.
In the long term improved post-operative management of patients
through increasing understanding in the wider medical profession will
hopefully lead to improved outcomes after surgery.

11. CC marking CC BY-SA
Given the expertise required for modifying slides I would suggest to
either use a slide as given or to add one’s own slides to avoid
misrepresentation of the content.