Presentation on theme: "Ethos of Enhanced Recovery After Surgery Implementation of ERAS"— Presentation transcript:
1 Ethos of Enhanced Recovery After Surgery Implementation of ERAS The role of Physiotherapy in the Nottingham Upper GI Enhanced Recovery After Surgery ProjectEthos of Enhanced Recovery After SurgeryThorough pre-op preparation of patientUse of minimally invasive techniquesMilestones agreed by patients and cliniciansMDT approachAccess to treatment – 365 days yearRapid mobilisation post-opThe Upper GI ERAS project was developed to focus on reducing the length of stay for patients undergoing oesophagectomy or gastrectomy at the Nottingham City Campus.The Physio Role - Evidence shows that early mobilisation post oesophagectomy and gastrectomy improves outcomes and reduces associated complications such as DVT and chest infection. While mobilisation has always been a priority for post op physio, we found we could standardise and improve this further during the ERAS project. This was achieved by developing milestones that are met by the patient daily which are progressively more demanding. The patient is made aware of these milestones pre-operatively and encouraged to aim towards them daily post op. At pre-op assessment, patients are encouraged to stop smoking if appropriate and increase their cardiovascular activity. The post op milestones include breathing and chest clearance exercises as well as mobility goals.PRACTICE pre-ERASLess structured pre-op assessmentConservative mobilisation in early post-op periodPatients less independent with treatmentReady for home day 12-14Implementation of ERASMilestones agreed preoperatively with patientPatient encouraged to exercise at home pre-op as chemo allows.Smoking cessation encouraged by MDTMore aggressive mobilisation post opUse of incentive spirometry to guide patients chest exercisesMDT reinforce milestones and aim for joint goalsUse of Band 3 Physio assistant to progress mobilisationMore frequent physio sessionsUse of minimally invasive techniques and alternative analgesia to reduce hypotension and allow mobilisationOUTCOMESPatients are better prepared for post-op journeyRapid return to mobilisationLess respiratory complicationsIndependence gained quickerPatient takes better ownership of their recoveryReady for home day 8Audit data shows…Patients report that they find the milestones provide a clear pathway which they can work to. They appreciate receiving this information pre-operatively so that they can prepare themselves for the challenge.We found patients can meet their milestones regardless of age and co-morbidity in the majority of cases and some catch up even if they have had a complication post op.Patients return to the ward on day one in the majority of cases and gain independence quickly.Length of stay has reduced from days to 8-11 days in the majority of cases.CONTACTSCath McLoughlinClinical Lead PhysioLaura MaddisonSenior Physionhs.ukReference list available on requestThe future…Work on patients pre-op physical activity level to enhance post-op mobilityEven earlier return to mobilityPost discharge rehabilitation clinic which would include exercise sessions combined with an advice /support component.Provision of a 7 day enhanced recovery physio service.