At St. Barts department of perioperative medicine we have a well established and expanding enhanced recovery after cardiac surgery (ERACS) programme. This relies on collaborative effort and enthusiasm from cardiac surgery, anaesthesia, critical care, nursing and allied health professionals to implement the pathway.

Cases are screened to ensure they are appropriate to be enrolled in this service, but we aim to be as inclusive as possible to give the highest number of patients the opportunity for ERACS. This is a holistic approach to patient care, encompassing vital aspects of the patient journey including outpatient pre-assessment, intra-operative and critical care management, all the way to discharge.

Examples of enhanced recovery we implement are modern fasting (sip-to-send), pre-op carbohydrate loading drinks, early wake-up, mobilisation and removal of lines, as well as an aim to discharge on day 4 postoperatively if safe to do so. A 7-day safety net phone consultation is offered to all patients following discharge and we also provide patients with pre-education including prescribed mobilisation exercises.