A few months ago, Lincoln Medical Partners Surgeon Dr. Garth Miller was rounding on surgical patients on the Miles Campus of LincolnHealth when a man he had operated on just hours before walked up to him in the hallway and asked if he could go home.

“He said he was feeling great. He had just had dinner,” remembered Miller. The man was not only on his feet hours after undergoing a bowel resection; he was dressed in his street clothes. “I did a double take. I didn’t recognize him at first because he looked like a visitor.”

A year earlier, that same patient could expect a hospital stay of anywhere from two to five days, and potentially two weeks, with a return to normal activities in a month to six weeks.

Now, with LincolnHealth’s Enhanced Recovery after Surgery (ERAS) program, patients are on their feet the day of surgery and often home in a day or two. They are back to their normal routine in as little as two weeks.

Dr. Miller still uses words like amazement and excitement when he talks about ERAS.

“It makes me feel very satisfied that patients are doing so well so quickly. We are still in the amazement phase of this. We are not taking it for granted.”

Because patients are on their feet sooner after surgery, they are less likely to develop blood clots, pneumonia and other conditions associated with long hospital stays. And shorter stays in the hospitals are not only safer and easier for patients, they are also cheaper.

A full year after the ERAS program was implemented; there have been no postoperative complications and no hospital readmissions.

Putting in place a whole new set of procedures both before and after surgery, however, was not easy.

“ERAS is a complicated program to carry out and implement because there are so many changes,” said Dr. Miller.

Just about every part of the organization had to change the way it dealt with surgical patients beginning with the first instructions patients receive in practice offices to the discharge instructions they are given when they leave the hospital.

Under ERAS, patients are given a clear liquid drink a few hours before surgery. Before ERAS, patients were told not to eat anything after midnight on the night before their surgery.

“We used to think it was dangerous for people to have a lot of food before surgery. And we were also afraid that if their stomach was full they might vomit, aspirate and get fluid in their lungs,” said Beverly Squillante, RN, clinical quality reviewer.

Studies have shown, said Dr. Miller, that in most cases, eating immediately following colon surgery is not only not harmful, it is actually beneficial.

“We now understand that not eating after surgery is one of the primary causes of colon paralysis, or ileus, which can delay patients’ recoveries,” he said.

“Prolonged starvation actually slows recovery. Studies have shown if you can keep the intestinal tract functioning, it will continue to function,” said Squillante.

Another significant change is a shift away from narcotic pain medications that have also been found to be a culprit in causing ileus.

In place of narcotic pain medications, anesthesiologists are using something called a TAP (transverse abdominis plane) block, essentially using a local anesthesia injected in the abdominal wall muscles to provide pain relief that can last several days – similar to a long lasting injection of Novocain.

Intravenous forms of over-the-counter pain relievers like Tylenol and Advil have also been found to be extremely effective in reducing pain without the side effects associated with narcotics, including the risk of dangerous addiction.

Making all those changes in about six months was possible because of the community hospital’s cohesive staff and a culture of quality and safety, said Squillante.

This same culture has helped LincolnHealth earn the Leapfrog Group’s prestigious Top Rural Hospital award in four of the past five years.

The change is all the more noteworthy because LincolnHealth was the first hospital in the MaineHealth system to implement the ERAS program.

Squillante said LincolnHealth’s culture of quality and safety grows naturally out of a connection to community.

In a hospital like LincolnHealth, people are more likely to know patients as friends and neighbors and that makes meeting quality goals and adopting new programs to improve care a little more personal and that much more important.

When it comes to programs like ERAS, the bottom line is care that is safer, less expensive and just plain better.