1. Enhanced Recovery Programme Helping patients to get better sooner after surgery

2. What is enhanced recovery?
Is a novel approach to elective surgery, ensuring that patients are in the optimal condition for treatment, have the best possible care during their operation, and experience optimal post-operative rehabilitation
Patients on enhanced recovery pathways recover more quickly following surgery
Enhanced Recovery Programmes (ERPs) are often referred to as Rapid, Accelerated Recovery or Fast Track surgery
They should involve the whole health community 2

3. History Early 2000: Prof Henrik Kehlet, Copenhagen
Orthopaedic models such as Accelerated or Rapid Recovery have been in existence in England also since early 2000
Clinician-driven programme
UK has piecemeal approach not maximising benefit for patients
Why has it not spread across the NHS when benefits are clearly reported? 3

4. Colorectal Surgery: Length of stay Large Intestine: Major Procedures
days

5. Factors Influencing Patient Recovery

6. Benefits being realised...6

7. Additional benefits Early detection of complications Decrease in HAI
Patient safety
Improved quality of care
Empowered patients
Harmonisation of care across NHS
Knowledge of outcomes
Team building
Local education
Improved focus on use of technology
Closer working partnerships (primary care and acute)
WCC Quality service commissioned
Improved reputation of Trust
International profile of care 7

8. Example of enhanced recovery elements
Optimising pre operative haemoglobin levels
Managing pre existing co morbidities e.g. diabetes
Admission on day
Optimised Fluid Hydration
CHO Loading
Reduced starvation
No / reduced oral bowel preparation ( bowel surgery)
Referral from
Primary Care
Planned mobilisation
Rapid hydration & nourishment
Appropriate IV therapy
No wound drains
No NG (bowel surgery)
Catheters removed early
Regular oral analgesia
Paracetamol and NSAIDS
Avoidance of systemic opiate-based analgesia where possible or administered topically
Pre-
Operative
Admission
Optimised health / medical condition
Informed decision making
Pre operative health & risk assessment
PT information and expectation managed
DX planning (EDD)
Pre-operative therapy instruction as appropriate
Intra-
Operative
Minimally invasive surgery
Use of transverse incisions (abdominal)
No NG tube (bowel surgery)
Use of regional / LA with sedation
Epidural management (inc thoracic)
Optimised fluid management Individualised goal directed fluid therapy
Post-
Operative
DX when criteria met
Therapy support (stoma, physio)
24hr telephone follow up
Follow Up 8

9. Critical success factors and barriers
Leadership and clinical engagement – 5-prong approach – consultant, anaesthetist, nursing/AHP, executive/management and primary care /commissioning
Engagement/communication with patients and staff
Capability and education
Information
Culture
Barriers
Absence of the above

10. ‘And to do this in 2 years not 20!’ Professor Sir Mike Richards, SRO
ER Programme’s aim
‘And to do this in 2 years not 20!’
Professor Sir Mike Richards, SRO
To improve the quality of patients care, through improving their clinical outcomes and experience, and reduce the length of elective care inpatient pathways across the NHS by utilising the good practice principles of enhanced recovery models of care. 10

11. Quality and productivity
With the recognised need for the NHS to make billions of pounds worth of efficiency savings during while still focussing on quality improvement, the Enhanced Recovery Partnership Programme is perfectly placed to make a significant contribution.
The programme delivers:
Improved quality of patient care
Improved quality of working life
Innovative pre-, peri- and post-operative
techniques are recognised to make a real
difference to patient experience
Shorter length of stay increases productivity
Making sure the patient is in optimal health
condition before surgery minimises risk
(works towards prevention) of readmission
and re-operation

12. The Impact 12

13. Colorectal & MSK Case Studies results

14. What the patients say!

15. Further questions / information 15