so I’ve been a surgeon for more than 30
years now it’s just wondering if there’s
anybody in the room who knows somebody
who’s had an operation or perhaps you’ve
had one yourself
can I see a race of hands oh wow
but you know so did I I was a surgeon’s
patient also and you know it took that
patient experience for me to understand
what it’s like to go to the hospital and
for once feel small and vulnerable to
lie in that hospital bed after the
operation and see medical practitioners
come by one after another checking out
their Shores throughout the day picking
their own particular part of the process
that they wanted to check I also know
what it’s like to lie there in bed and
just want to recover quickly without
complications and go home
but you know as a surgeon I know that
surgery can be dangerous despite all the
technical and medical advances that we
made over the years people are still
gonna suffer severe complications now
picture yourself and three close ones
having an operation one of you is gonna
have a complication and no matter what
some people still die after what we
would regard as standard procedures but
there’s a huge difference between some
hospitals and others and there are
studies from Europe that would say that
you know the risk of dying after a major
operation may be 10 to 15 fold greater
in one country over another and believe
it or not but for the same operation you
may have to stay in the hospital three
weeks to recover in one hospital while
in another one it will take you three
days to be perfectly fine and go home
so you see if I’m gonna have another
surgery I would choose my hospital very
carefully now what may surprise you a
little bit is how I make that choice
you see I wouldn’t necessarily go to the
most modern hospital with the fanciest
machines and equipment and what have you
no there’s something else that I’m
looking for so what is it then with most
hospitals that makes some so much better
than others and how can we deal with
that problem and why is it that the idea
that I’m gonna tell you about today is
about to cause a revolution in surgery
so let’s start with what is the problem
let’s together move back a little bit
and reflect on something I’m sure
everybody knows that you’re not allowed
to have anything to drink from midnight
to the day of that operation right well
if you just have as much as a sip of
water perhaps while you’re brushing your
teeth that morning you’re probably gonna
die on that operating table right well
it’s probably the best known medical
rule in the world but you know what it’s
nonsense it’s completely false it’s
wrong and still this is being practiced
in just about every hospital around the
world you see old habits die hard the
problem is that this is not the only one
of these old traditional treatments that
we impose on patients around the world
today and why is that well let me take
you back a little bit in history a long
time ago as I’m sure you can see on the
picture I met with a fine surgeon from
Edinburgh Ken theorem and he and I had
the idea that we would for the first
time put together the ideal protocol for
major surgery everything that we do
around it we would put together best
practice so we gathered a team of expert
colleagues to join us in a project that
we called enhanced recovery after
surgery or short
so together we scanned all the
literature that we could find that had
any bearing on the outcomes of patients
undergoing surgery and put together that
ideal protocol the guideline when we
looked at it we realized none of us were
doing it and we were all doing
differently so we decided to do a survey
in the five countries that we
represented and found nobody was doing
it why was that well then we realized we
were up against something really big
Hospital organization okay well you see
we’ve developed hospital care in
departments surgery anesthesia intensive
care all moving more and more into
specialization all getting more and more
technically advanced which is fine and
dandy because that is actually one of
the reasons we have some of the better
results today compared to what we had
years ago but the problem is that the
more advanced each one of them become
the further apart they grow and
communication between them is like
communication between silos very poor
you see you have surgeons
anesthesiologist nurses physiotherapists
focusing on their own little part of
that patients journey not caring about
anything else but that not seeing what
might be good or bad for the patient
later on let me give you an example we
can often use fluids to manage blood
pressure during during anesthesia and
surgery now that may solve the problem
for that particular period of time the
problem is that very often the patient’s
gets way too much fluids and it’s not
uncommon that you would have a patient
come off the operating table increasing
their weight by 6 8 or even 10 pounds
just water inside the body is very
uncomfortable for the patient it
certainly will delay recovery and it can
cause some serious complications are you
beginning to see the problem that we
discovered you see
nobody has the the overview of the
entire patient’s journey nobody controls
the different elements nobody sees the
entire picture so despite all the best
of intentions we have a huge problem
right so the issue is now how could we
deal with this and have best practice
being introduced well traditionally Ken
and I be insurgents we would look at
these things from our own point of view
the surgical view but this time we tried
something completely different we took
another view we took the patient’s view
that’s the only one who actually does
the entire journey and this is where we
found the solution so this is what IRA’s
is of today and it’s based on one of the
oldest skills that we have communication
between people so the way that we train
people today is that we bring best
practices to them using this new
approach the patient’s view so we train
hospitals to form an arrest team have
them sit around the table making sure we
cover every one of the silos that the
patient is passing through
we take them beyond the checklist we
take them trained to communicate in a
way that they never did before well you
may think we’ve done this forever but
it’s we haven’t actually not this way
you see now we have the surgeons and the
anesthesiologist who take the medical
decisions making sure we move away the
old outdated traditional care elements
and put in the new updated ones but they
don’t do it in isolation one on one on
their own no this time they do it
together to make sure that we harmonize
the patient’s journey and the nurses
around the table the ones that actually
carry out the work that it has to be
done they know what functions and what
doesn’t and they bring that to the table
together with the dietitians the
physiotherapist and any other health
practitioner out there they make sure to
refine the entire protocol now the other
thing they do is they gather information
about every patient that goes through
their service and they come together on
a way
limiting the entire team and audit what
is going on they audit their data they
see the outcomes but also the processes
behind them this is how they target
their improvements and make sure that
those improvements are sustained they
also communicate to the rest of the team
out there what each and everyone’s role
is in the bigger picture and at the core
of it all the patient the patient is
given full information of what to expect
during the surgical journey this
empowers patients to take an active part
in their own recovery so
IRA’s you could look at it as the human
to human link that secures that
technology is not pushing us apart now
I’m happy to say that this revolution
has already started we begun in 2010 to
implement these programs and it’s now
spreading across the world well you may
say this is not rocket science and
perhaps it isn’t them but it’s extremely
powerful and you know why it’s moving so
fast it’s because of the outcomes I’m
gonna show you in just a moment but
before I do just keep in the back of
your mind if this was a new drug a pill
that was produced by the pharmaceutical
industry I think you will agree it would
be a billion dollar seller in no time
because look at this patients will
recover with only half the complications
they recover much quicker and much more
comfortably this brings down the need of
hospital stay from what used to be weeks
to days and for the hospitals and other
healthcare organizations costs are
coming down sometimes dramatically and
we just found in our own study that we
just published that we may even improve
survival after some cancer surgeries so
quite amazing isn’t it so the w-h-o the
World Health Organization is predicting
that this year 320 million operations
are going to be performed that would
result in six
80 million complications now just
imagine for a moment if we could have
eras out there as a standard of care for
everyone my vision is that we would be
able to reduce complications for maybe
10 20 or even 30 million people you see
the next revolution in surgery is going
to be based on something that has been
with us all the time talking to each
other so the next time or if you is for
you it’s the first time you go for a
surgery I think you should do what I
would do
look your surgeon straight in the eye
and ask him do you have the era’s
protocol in place in your practice thank
you for listening
[Applause]
you
years now it’s just wondering if there’s
anybody in the room who knows somebody
who’s had an operation or perhaps you’ve
had one yourself
can I see a race of hands oh wow
but you know so did I I was a surgeon’s
patient also and you know it took that
patient experience for me to understand
what it’s like to go to the hospital and
for once feel small and vulnerable to
lie in that hospital bed after the
operation and see medical practitioners
come by one after another checking out
their Shores throughout the day picking
their own particular part of the process
that they wanted to check I also know
what it’s like to lie there in bed and
just want to recover quickly without
complications and go home
but you know as a surgeon I know that
surgery can be dangerous despite all the
technical and medical advances that we
made over the years people are still
gonna suffer severe complications now
picture yourself and three close ones
having an operation one of you is gonna
have a complication and no matter what
some people still die after what we
would regard as standard procedures but
there’s a huge difference between some
hospitals and others and there are
studies from Europe that would say that
you know the risk of dying after a major
operation may be 10 to 15 fold greater
in one country over another and believe
it or not but for the same operation you
may have to stay in the hospital three
weeks to recover in one hospital while
in another one it will take you three
days to be perfectly fine and go home
so you see if I’m gonna have another
surgery I would choose my hospital very
carefully now what may surprise you a
little bit is how I make that choice
you see I wouldn’t necessarily go to the
most modern hospital with the fanciest
machines and equipment and what have you
no there’s something else that I’m
looking for so what is it then with most
hospitals that makes some so much better
than others and how can we deal with
that problem and why is it that the idea
that I’m gonna tell you about today is
about to cause a revolution in surgery
so let’s start with what is the problem
let’s together move back a little bit
and reflect on something I’m sure
everybody knows that you’re not allowed
to have anything to drink from midnight
to the day of that operation right well
if you just have as much as a sip of
water perhaps while you’re brushing your
teeth that morning you’re probably gonna
die on that operating table right well
it’s probably the best known medical
rule in the world but you know what it’s
nonsense it’s completely false it’s
wrong and still this is being practiced
in just about every hospital around the
world you see old habits die hard the
problem is that this is not the only one
of these old traditional treatments that
we impose on patients around the world
today and why is that well let me take
you back a little bit in history a long
time ago as I’m sure you can see on the
picture I met with a fine surgeon from
Edinburgh Ken theorem and he and I had
the idea that we would for the first
time put together the ideal protocol for
major surgery everything that we do
around it we would put together best
practice so we gathered a team of expert
colleagues to join us in a project that
we called enhanced recovery after
surgery or short
so together we scanned all the
literature that we could find that had
any bearing on the outcomes of patients
undergoing surgery and put together that
ideal protocol the guideline when we
looked at it we realized none of us were
doing it and we were all doing
differently so we decided to do a survey
in the five countries that we
represented and found nobody was doing
it why was that well then we realized we
were up against something really big
Hospital organization okay well you see
we’ve developed hospital care in
departments surgery anesthesia intensive
care all moving more and more into
specialization all getting more and more
technically advanced which is fine and
dandy because that is actually one of
the reasons we have some of the better
results today compared to what we had
years ago but the problem is that the
more advanced each one of them become
the further apart they grow and
communication between them is like
communication between silos very poor
you see you have surgeons
anesthesiologist nurses physiotherapists
focusing on their own little part of
that patients journey not caring about
anything else but that not seeing what
might be good or bad for the patient
later on let me give you an example we
can often use fluids to manage blood
pressure during during anesthesia and
surgery now that may solve the problem
for that particular period of time the
problem is that very often the patient’s
gets way too much fluids and it’s not
uncommon that you would have a patient
come off the operating table increasing
their weight by 6 8 or even 10 pounds
just water inside the body is very
uncomfortable for the patient it
certainly will delay recovery and it can
cause some serious complications are you
beginning to see the problem that we
discovered you see
nobody has the the overview of the
entire patient’s journey nobody controls
the different elements nobody sees the
entire picture so despite all the best
of intentions we have a huge problem
right so the issue is now how could we
deal with this and have best practice
being introduced well traditionally Ken
and I be insurgents we would look at
these things from our own point of view
the surgical view but this time we tried
something completely different we took
another view we took the patient’s view
that’s the only one who actually does
the entire journey and this is where we
found the solution so this is what IRA’s
is of today and it’s based on one of the
oldest skills that we have communication
between people so the way that we train
people today is that we bring best
practices to them using this new
approach the patient’s view so we train
hospitals to form an arrest team have
them sit around the table making sure we
cover every one of the silos that the
patient is passing through
we take them beyond the checklist we
take them trained to communicate in a
way that they never did before well you
may think we’ve done this forever but
it’s we haven’t actually not this way
you see now we have the surgeons and the
anesthesiologist who take the medical
decisions making sure we move away the
old outdated traditional care elements
and put in the new updated ones but they
don’t do it in isolation one on one on
their own no this time they do it
together to make sure that we harmonize
the patient’s journey and the nurses
around the table the ones that actually
carry out the work that it has to be
done they know what functions and what
doesn’t and they bring that to the table
together with the dietitians the
physiotherapist and any other health
practitioner out there they make sure to
refine the entire protocol now the other
thing they do is they gather information
about every patient that goes through
their service and they come together on
a way
limiting the entire team and audit what
is going on they audit their data they
see the outcomes but also the processes
behind them this is how they target
their improvements and make sure that
those improvements are sustained they
also communicate to the rest of the team
out there what each and everyone’s role
is in the bigger picture and at the core
of it all the patient the patient is
given full information of what to expect
during the surgical journey this
empowers patients to take an active part
in their own recovery so
IRA’s you could look at it as the human
to human link that secures that
technology is not pushing us apart now
I’m happy to say that this revolution
has already started we begun in 2010 to
implement these programs and it’s now
spreading across the world well you may
say this is not rocket science and
perhaps it isn’t them but it’s extremely
powerful and you know why it’s moving so
fast it’s because of the outcomes I’m
gonna show you in just a moment but
before I do just keep in the back of
your mind if this was a new drug a pill
that was produced by the pharmaceutical
industry I think you will agree it would
be a billion dollar seller in no time
because look at this patients will
recover with only half the complications
they recover much quicker and much more
comfortably this brings down the need of
hospital stay from what used to be weeks
to days and for the hospitals and other
healthcare organizations costs are
coming down sometimes dramatically and
we just found in our own study that we
just published that we may even improve
survival after some cancer surgeries so
quite amazing isn’t it so the w-h-o the
World Health Organization is predicting
that this year 320 million operations
are going to be performed that would
result in six
80 million complications now just
imagine for a moment if we could have
eras out there as a standard of care for
everyone my vision is that we would be
able to reduce complications for maybe
10 20 or even 30 million people you see
the next revolution in surgery is going
to be based on something that has been
with us all the time talking to each
other so the next time or if you is for
you it’s the first time you go for a
surgery I think you should do what I
would do
look your surgeon straight in the eye
and ask him do you have the era’s
protocol in place in your practice thank
you for listening
[Applause]
you
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