Total ERAS: four domains of a Perioperative Medicine Programme

Postoperative morbidity and mortality in United Kingdom is a serious public health burden.  Perioperative clinicians are changing the way they work to integrate care throughout the entire perioperative patient journey from contemplation of surgery to completion of recovery.   Irrespective of surgical speciality or urgency the perioperative  pathway can be though of as four core domains. (Figure  below)


  • Enhancing risk assessment for surgery 
  • Enhancing risk adjustment (optimising) for surgery
  • Enhancing recovery after surgery 
  • Enhancing rescue (from illness) after surgery 


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A list of ideas under each domain is below the infographic

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Additional Information on the Total ERAS Vision

We want digital transformation of perioperative care to be centred around a patient journey not a speciality silo or temporal segment of care.  True perioperative medicine integrates the patient journey from contemplation of surgery to completion of recovery.  

Total ERAS: enhacned risk assessment for surgery

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Total ERAS enhanced risk adjustment for surgery

  • Enhanced risk adjustment (to include  resource allocation): 
    • Use of TMS & ICD 10 data to automate perioperative planing & assessment so information handover between theatre and recovery is optimised to improve safety of patient admission and discharge planning into and out of theatre complex.
    • Development of application to facilitate emergency list co-ordaination, especially at times of high demand.
    • Develop a pateint platform to support personal control and participation prehabilitation for surgery. 


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Total ERAS: enhacned recovery after surgery

  • Enhanced recovery:  
    • Using TMS data to predict length of stay in recovery
    • Develop personal pain scoring and analgesia record to facillitate optimisation of post operative analgesia for bet recovery

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Total ERAS: enhacned rescue after surgery

  • Enhanced rescue: 
    • Using AI to recognise pneumothorax and alert the patients physician immediately.
    • Developing tools for patients and carers to support escalation and ceiling of care plans
    • Leverage power of AI in fluid prescribing 

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