Table 1 Unique elements of the CHASE protocol and responsibilities of HCPs
Phase | CHASE element | Responsible HCP |
|---|---|---|
Preoperative: | CHASE counselling | Nurse practitioner |
Admission on the day of surgery | Planner | |
Preoperative analgesia with paracetamol and gabapentin | Nurse surgical ward and ward physician | |
Walk to the operation theatre | Nurse surgical ward | |
Perioperative: | Spinal anaesthesia with hyperbaric bupivacaine (Marcaine) before induction | Anaesthesiologist |
Fluid therapy: only limited balanced crystalloids set at 3 mL/kg/h | Anaesthesiologist and anaesthesiology assistant | |
Starting intra-abdominal pressure 12 mmHg, which is reduced to 8 mmHg after trocar placement | Operation nurse | |
Intracorporeal primary anastomosis | Surgeon | |
Specimen extraction through Pfannenstiel incision | Surgeon | |
Postoperative: | Analgesics with Meloxicam, Paracetamol and if necessary Oxycodone | Nurse and ward physician |
The quick stimulus of intake with an ice popsicle | Recovery room nurse | |
Stop of IV-fluids Postoperative day (POD) 0–1 | Nurse surgical ward | |
Early mobilization on POD0 | Nurse surgical ward | |
Discharge on POD1 if the patient meets the following criteria: pain under control with oral analgesics (VAS < 4); no symptoms of nausea and/or vomiting; flatus or passing of stool; oral intake possible; spontaneous micturition; able to mobilize independently; no fever, tachycardia, hypotension, dyspnoea, or somnolence; confidence to go home. Patients who do not meet all the discharge criteria remain admitted until they meet all criteria | Ward physician | |
Follow-up with a telephone consultation by the nurse on POD 1 and the nurse practitioner on POD 3 to evaluate recovery | Nurse practitioner |