ERAS: The Enhanced Recovery Course

1. 1.1 What ERAS actually is5 min
2. 1.2 Why it works: the stress response7 min
3. 1.3 The evidence, and the honest limits7 min
4. 1.4 The whole pathway at a glance8 min
5. 1.5 ERAS in the Ethiopian hospital6 min

Objectives. Define Enhanced Recovery After Surgery (ERAS) and distinguish it from conventional perioperative care. Explain how ERAS elements attenuate the surgical stress response and reduce insulin resistance. Summarise the evidence for ERAS on length of stay, complications, readmission and cost. Describe the relationship between protocol adherence and patient outcome. Map the 20+ ERAS elements onto the pre-, intra- and postoperative phases of care. Identify what ERAS implementation requires in a resource-constrained Ethiopian hospital.

1. 2.1 Screening: find it before theatre finds it8 min
2. 2.2 Fasting and carbohydrate loading7 min
3. 2.3 Bowel preparation: settling the argument6 min
4. 2.4 Prophylaxis: infection, clots and vomiting9 min
5. 2.5 Prehabilitation you can actually deliver6 min

Objectives. Screen surgical patients for anaemia, malnutrition, poor glycaemic control, smoking and alcohol use, and act on each finding. Apply ERAS fasting rules and prescribe preoperative carbohydrate loading, including in diabetes. Justify the current position on mechanical bowel preparation and oral antibiotics. Select and time antimicrobial prophylaxis, thromboprophylaxis and PONV prophylaxis for an individual patient. Deliver structured preoperative education that sets recovery expectations and assigns the patient a role. Design a prehabilitation plan that is deliverable without a gym or a dedicated physiotherapist.

1. 3.1 Team readiness and the checklist that works7 min
2. 3.2 An anaesthetic built for recovery9 min
3. 3.3 Multimodal analgesia and the opioid problem10 min
4. 3.4 Fluids and temperature9 min
5. 3.5 Technique, efficiency, and the tube decision10 min

Objectives. Run the WHO Surgical Safety Checklist as a communication event rather than a form-filling exercise. Select an anaesthetic technique that supports early recovery, and justify the choice. Construct a multimodal, opioid-sparing analgesic plan including a regional technique. Apply goal-directed fluid therapy to a slightly positive balance and defend the target. Maintain normothermia with the equipment actually available. Decide — with a written removal trigger — whether a drain, nasogastric tube or catheter is indicated at all.

1. 4.1 Feed them8 min
2. 4.2 Move them8 min
3. 4.3 Postoperative ileus9 min
4. 4.4 The ERAS ward round9 min
5. 4.5 Discharge and what happens next6 min

Objectives. Start oral intake within 24 hours of surgery and manage the common objections to doing so. Deliver structured early mobilisation to the 2025 target and document it. Prevent, recognise and manage postoperative ileus, distinguishing it from mechanical obstruction. Run a ward analgesia round that keeps the multimodal plan intact. Remove tubes and catheters on schedule and escalate appropriately when a patient deviates from the pathway. Apply objective discharge criteria and arrange structured follow-up.

1. 5.1 The patient is not a passenger6 min
2. 5.2 The ten-minute session8 min
3. 5.3 Literacy, language and family7 min
4. 5.4 Consent as a conversation8 min
5. 5.5 Handing the pathway to the patient7 min

Objectives. Explain why patient education is an ERAS element with an outcome effect, not a courtesy. Deliver a structured preoperative education session covering expectations, milestones and the patient's own tasks. Use teach-back to verify understanding rather than assuming it. Adapt information for low literacy, for Amharic and other local languages, and for family decision-making. Take informed consent as a process of shared understanding rather than a signature. Use a patient diary or milestone card to transfer part of the pathway to the patient.

1. 6.1 Who does what9 min
2. 6.2 The coordinator and the leadership7 min
3. 6.3 Communication that survives a handover8 min
4. 6.4 Why pathways fail, and what to do8 min
5. 6.5 Building your team6 min

Objectives. State the ERAS responsibilities of each core team member across all three phases. Describe the ERAS coordinator role and why a pathway without one usually stalls. Use structured communication tools — SBAR, briefing, huddle, structured handover — in perioperative practice. Identify the common barriers to ERAS implementation and match each to a realistic counter-strategy. Describe what hospital leadership must supply for an ERAS programme to survive. Speak up effectively across a professional hierarchy, and receive a challenge well.

1. 7.1 Why measure at all6 min
2. 7.2 The audit cycle and its standards9 min
3. 7.3 What to measure9 min
4. 7.4 Making the data change behaviour9 min
5. 7.5 Making change stick7 min
6. 7.6 Capstone: your 90-day plan6 min

Objectives. Distinguish clinical audit from research and from service evaluation, and know why it matters. Write SMART, evidence-based audit standards for ERAS elements. Design a data collection form and choose a defensible sample. Select balanced process, outcome and balancing indicators for an ERAS programme. Analyse compliance data and present it so that a clinical team acts on it. Run a PDSA cycle, close the audit loop with a re-audit, and sustain the change. Produce a 90-day ERAS improvement plan for your own unit.