Enhancing Surgical Recovery - Health Quality Ontario (HQO)

2022-23 Surgical Quality Improvement Campaign

Hospitals are coming together for a second year to enhance patient care, support pandemic recovery and help ease the surgical backlog in Ontario. Enhancing Surgical Recovery aims to improve care before, during and after surgery — so patients feel better faster and can get back to their daily lives.

How to get started

For the second year of this campaign, choose at least one surgery type and commit to improve at least one surgical outcome by 20%:

Surgical outcome

Surgical site infections (SSIs);
Urinary tract infections (UTIs);
Pneumonia;
Pulmonary embolism; and/or
Deep vein thrombosis.

Plus, monitor your progress along the way and track the impact of your improvements on hospital length of stay. Hospitals are also encouraged to reflect on how they may commit to improving the provision of equitable surgical care.

Enhancing Surgical Recovery is the third “Committed to Better” campaign involving 46 hospital sites across Ontario that are part of the Ontario Surgical Quality Improvement Network.

Why enhance care before, during and after surgery?

Enhanced Recovery After Surgery (ERAS) is an evidence-based, best practice care model that standardizes care before, during and after surgery, reducing surgical complications and shortening hospital stays.

ERAS offers guidelines on eating and drinking, mobility after surgery, anesthesia and pain control, and helps health-care providers and their patients and caregivers better plan and prepare for surgery together.

The Enhancing Surgical Recovery campaign is designed to help surgical teams either implement ERAS at their hospital for the first time, or expand on their existing commitment to ERAS best practices by applying it to other surgical procedures.

By continuing to enhance surgical care at your hospital, you’ll help patients feel better faster so they can get back to their daily lives, easing the surgical backlog and supporting pandemic recovery across the province.

Approximately 72% of patients undergoing surgery in the province will be discharged from an Ontario Surgical Quality Improvement Network member hospital.

Follow these steps

Between April 1, 2022, and March 31, 2023, Surgical Network hospitals, supported by Ontario Health, will make a commitment to Enhancing Surgical Recovery by implementing or spreading ERAS best practices for at least one surgery type with the aim of improving at least one surgical outcome.

Choose at least one surgical type for your hospital to focus on (e.g. colorectal, emergency general surgery, gynaecological and/or orthopaedic).
Select at least one surgical outcome to improve by 20%: surgical site infections, urinary tract infections, pneumonia, pulmonary embolism, and/or deep vein thrombosis.
Focus on at least one part of the surgical process (pre-admission, pre-operative care, perioperative care, or post-operative care) and select one of the related change ideas to implement.
Track your progress: Collect data using the process and balancing measures below to help you determine the success of your approach and its impact on patients and hospital length of stay.

Process Measures
- Full list of process measures available here.
Balancing Measures*
- Length of stay
- Rate of readmission
- Patient satisfaction and pain rating
*Balancing measures help ensure changes implemented to improve one element of patient care are not causing new problems in other areas of care.
Ontario Surgical Quality Improvement Network members: Indicate your participation in this campaign in your Surgical Quality Improvement Plans. The primary indicator for this campaign—20% improvement in at least one surgical outcome—will be available in the drop-down menu. Patient length of stay will also be monitored for improvement.

Not a member? No problem – send an email to ONSQIN@ontariohealth.ca to find out how your hospital can join the campaign and take on the Enhancing Surgical Recovery challenge.

Tools and resources

Quality Standard: Transitions Between Hospital and Home
This quality standard addresses care for people of all ages transitioning (moving) between hospital and home after a hospital admission. It focuses on people who have been admitted as inpatients and who require ongoing coordinated follow-up medical care, including medication and opioid review and support, after discharge.

Share its accompanying patient guide with your patients to help them ask informed questions about their transition plan, including getting a written transition plan that includes information about taking their medications safely.

Quality Standard: Opioid Prescribing for Acute Pain
Learn more about opioid prescribing for acute pain using this quality standard produced by Ontario Health in consultation with clinical experts and patients. It outlines what high-quality care looks like for clinicians when they’re prescribing opioids and is based on the best evidence.

Share its accompanying patient guide with your patients to help them ask informed questions about opioid prescribing and additional techniques they can use to help manage their pain post-surgery.

NEW Quality Standard: Delirium
3 out of 4 older people may experience delirium after surgery — a sudden change in how someone thinks, acts or understands what’s happening to them. This new quality standard outlines what quality care looks like for delirium and is based on the best evidence.

Share its accompanying patient guide with your patients to help them ask informed questions about managing delirium after surgery.

MyPractice Report: General Surgery
General surgeons who perform appendectomies, cholecystectomies, and select hernia repairs can sign up to receive a confidential practice report that offers personalized data on your opioid prescribing patterns in relation to your peers. Suggestions and tools to support quality improvement efforts are also included.

MyPractice Report: Orthopaedic Surgery
Orthopaedic surgeons who perform hip and knee replacements can sign up to receive a confidential practice report that includes personalized data on your opioid prescribing patterns, along with suggestions to help improve care for your patients.

Quality Based Procedure: Cancer Surgery
A clinical handbook with best practice recommendations and an evidence-based framework for cancer surgery developed by the Ministry of Health with clinical advice from Ontario Health (Cancer Care Ontario).

Quality Based Procedure: Hysterectomy
A clinical handbook with best practice recommendations and an evidence-based framework for cancer surgery developed by the Ministry of Health with clinical advice from Ontario Health (Cancer Care Ontario).

Local Initiatives
Many organizations and hospitals are already taking steps to implement Enhanced Recovery After Surgery best practices and educate their patients and other health care providers about how they’re enhancing care before, during and after surgery.

If you’re a member of the Ontario Surgical Quality Improvement Network, you’ve been receiving updates about these local initiatives through the Surgical Network’s Community of Practice.

If you’re not a member, but are interested in learning more about local initiatives, email ONSQIN@ontariohealth.ca.

How to talk with your patients about enhancing surgical recovery

People who are about to have surgery might be apprehensive about the procedure and their recovery, especially during the pandemic. They may experience anxiety or fear about post-surgical pain affecting their daily lives. Plan and prepare for surgery, together — talk with your patients and their caregivers about what to expect at every stage of the surgical process.

Start the conversation:

Patient conversation guides for Transitions from Hospital to Home, Opioid Prescribing for Acute Pain, and Delirium (please share with your patients)
Poster for patients (for clinicians to print and hang in their waiting rooms)

Share your participation

Communications Materials
Celebrate and share that your hospital is taking on the Enhancing Surgical Recovery challenge. Here are some suggested communications tools you may find helpful:

Poster for clinicians (to print and hang in their surgical suites)
Poster for patients (for clinicians to print and hang in their waiting rooms)

Quorum
Members of the Ontario Surgical Quality Improvement Network can engage with others and exchange success stories and challenges on Quorum, an online quality improvement forum. Share tools, resources and best practices your team is using for Enhancing Surgical Recovery at your hospital.

About the Ontario Surgical Quality Improvement Network

The Ontario Surgical Quality Improvement Network is a Community of Practice that brings together surgical teams from all hospitals and specialties from across the province to improve the quality of surgical care.

For more information on the Enhancing Surgical Recovery campaign or to join the Ontario Surgical Quality Improvement Network, please contact ONSQIN@ontariohealth.ca.

Quality Improvement