Fast track surgery is a multimodal approach which requires successful organisation of the MDT, including surgeons, nurses and anaesthetists. It focuses on enhancing recovery and reducing morbidity by using evidence based care in the areas of:57
- anaesthesia
- analgesia
- reduction of surgical stress
- fluid management
- nutrition
- ambulation.
Recent research has highlighted that many of the traditional approaches to surgical care, such as pre-operative bowel preparation, the use of nasogastric tubes, enforced bed rest and the use of graduated diets may be unnecessary or even harmful.57 As these approaches to surgical management are reviewed, lengths of hospitalisation may be reduced. Prospective benefits of reduced hospitalisation may include reduced costs and morbidity.26 Lengthy hospital stays have been associated with lower Quality of Life (QOL) scores and higher post-operative complication rates in individuals undergoing surgery for colorectal cancer.26
Several key elements contribute to a successful fast track surgery and enhanced recovery program. These include:57
- optimal participant selection
- establishing evidence based clinical protocols
- commencing coordination of care pre-operatively
- changing people's expectations of their hospital stay
- establishing referral pathways and clinical coordination between acute and primary health sectors to ensure access to specialist services in a timely manner
- maintaining quality clinical care.
While reduced hospital stay and improved use of healthcare resources is a desirable outcome, these factors do not eliminate the need for high level supportive care. An SCN is ideally positioned to take on this role, providing day to day coordination, triage, clinical care, information, and psychosocial support from the point of entry to service through to surgery, initial recovery and follow up, providing ongoing support and appropriate referral.
Learning activity
Review the fast track protocol58 and:
- Describe the major challenges in implementing a fast track protocol
- Discuss the implications of fast track protocols for nurses.