1. Enhanced Recovery after Surgery WebEx 1
3rd November 2010
Good afternoon and Welcome to the first WebEx session for the Enhanced Recovery programme. I would like to introduce myself first of all. I am Mel Baker Programme manager for ERAS on 1000 Lives Plus. Rachael Barlow who is the clinical lead for ERAS can not be with us today so sends her apologies. Can I ask all attendees going down the list to introduce yourselves, what your role is with ERAS and what organisation you are from.
Enhanced Recovery after Surgery WebEx 1
Presenter: Mel Baker Programme Manager ERAS
Insert name of presentation on Master Slide

2. Agenda for WebEx 1 Welcome ERAS How to guide Driver diagram
Measures bundles
How is data going to be collected
Dates of events
Agenda for today
Welcomes
ERAS How to guide
Driver diagram
Measurement bundles
How is data going to be collected
Dates for your diaries
Questions: I am happy to take questions throughout this WebEx session but will review this as the call progresses as I need to cover all the measures so if we are running short of time then I may ask at some point during the call that participants hold all questions until the end.
Enhanced Recovery after Surgery WebEx 1

3. The Model for Improvement
What are we trying to
accomplish?
When you combine the 3 questions with the…
PDSA cycle, you get…
How will we know that a
change is an improvement?
What change can we make that will result in improvement?
Act
Plan
Study Do
…the Model for Improvement.
Enhanced Recovery after Surgery WebEx 1

4. ERAS How to guide
How to guide for Enhanced Recovery is going to be launched at the first Learning session for ERAS on 17th November 2010 in Llandrindod Wells
The ERAS how to guide is going to be launched at the first learning session with copies distributed to delegates. All of the following information on the drivers and driver diagram is taken directly out of the guide.
Electronic version of the how to guide will be available on ERAS 1000 Lives website after Learning session 1 on 17th November 2010.
Enhanced Recovery after Surgery WebEx 1

5. Enhanced Recovery after Surgery WebEx 1
Content area- improve surgical outcome for people undergoing major surgery
This is achieved by having 5 drivers with multiple interventions supporting each of these drivers. The drivers do incorporate all aspects of the patients journey with ERAS. Before I continue I do need to re-iterate this driver and interventions is set out for major abdominal surgery, we need to look at orthopaedic measures next. So a proportion of this driver and the bundles are not applicable to the orthopaedic speciality.
Aim- All drivers that are applicable to secondary care are completed to achieve best outcome for the patient. Primary Care will be involved within the next 6-12 months, there are talks ongoing at the moment to arrange involvement of GP’s, practice nurses etc…..
Drivers- there are 4 drivers applicable to secondary care. These being:
Diagnosis and Pre-operative assessment
Peri-operative bundle
Post-operative bundle
Discharge and follow-up care bundle
Interventions- these are elements of care that support the ERAS patient through there ‘surgical journey’ in a timely manner through improvement in quality and reduction in harm to the patient. These interventions form parts of the care bundles developed to support the work being undertaken in ERAS.
Enhanced Recovery after Surgery WebEx 1

6. Primary Care bundle Enhanced Recovery after Surgery WebEx 1
There are 6 elements to this bundle. Some of these elements form part of the Quality and outcomes framework achievement Data (QOF) which measures how practices are delivering on the GP contract.
These interventions help to support the end outcomes for the patients as we are ensuring the patient is optimised and prepared for surgery. This supports the work then carried out by POAC team in ensuring the work to optimise the patient for surgery continues.
This work will also focus on the communication between Primary care and POAC, this needs to be worked on to discuss ways where information is passed on in timely manner between Primary and secondary care to ensure both sides are aware of information pertinent to the patient.
Worked with this bundle will be starting in the next 6 months within pilot areas. Pilot areas TBC.
Enhanced Recovery after Surgery WebEx 1

7. POAC care bundle Enhanced Recovery after Surgery WebEx 1
There are 13 elements to this bundle. These interventions help to support the end outcomes for the patients as we are ensuring the patient is optimised and prepared for surgery. The work ensures the patient is informed of ERAS and what is expected of them, investigations are performed such as blood tests and Cpx testing, thromboprophylaxis screening performed and nutritional advise given.
These elements of the pathway ensure that the patient arrives for surgery in ‘the best’ condition we can optimise them too once embedded in to practice within Pre-operative assessment. They will support the patient in there recovery through the ERAS journey.
Compliance on this bundle will start from December 1st 2010 with the completed months data submitted by the 8th of the following month by the health boards nominated project leads.
Enhanced Recovery after Surgery WebEx 1

8. Peri-operative bundle
Peri-operative Care bundle
There are 13 elements to this bundle. These interventions help to support the end outcomes for the patients as we are ensuring the patient is optimised and prepared for the stress of surgery. The work ensures the patient is nutritionally prepared pre-operatively, they are admitted on day of surgery if there is no clinical reason to admit the night before surgery, thromboprophyalxis screening reviewed to ensure appropriate treatment is given as written in POAC assessment, goal directed fluid therapy to avoid dehydration etc…. These elements of the pathway ensure that the patient arrives for and goes through surgery in ‘the best’ condition we can optimise them too. They will support the patient in there recovery through the ERAS journey through to discharge and at home.
Compliance on this bundle will start from December 1st 2010 with the completed months data submitted by the 8th of the following month by the health boards nominated project leads.
Enhanced Recovery after Surgery WebEx 1

9. Post-operative bundle
Post-operative Care bundle
There are 7 elements to this bundle. All elements are research based and the focus is again quality care/’best practice’ for the ERAS patient. These interventions help to support the patients recovery and help reduce the number of complications post-operatively such as dehydration, thrombosis, infection etc….. As an example by getting the ERAS patient up and mobilising sooner than the ‘traditional’ surgical patient you will help to reduce the incidences of post operative complications such as DVT and PE.
Compliance on this bundle will start from December 1st 2010 with the completed months data submitted by the 8th of the following month by the health boards nominated project leads.
Enhanced Recovery after Surgery WebEx 1

10. Discharge and follow up bundle
There are 5 elements to this bundle. All elements in this bundle will support the patient in timely discharge home, the patient is discharged with the appropriate discharge follow up support and the care is reviewed after discharge to see how the patient felt it went. Timely discharges are vital, when planned well it avoids the unnecessary delays in obtaining the medication to send home with the patient, planning for discharge care needs addressed so the patient is not sat in hospital waiting for care package to be sorted and the patient has appropriate support at home from MDT to avoid re-admission back in to hospital due to problems, this is also supported by follow up calls made by the team to identify how they are doing.
Compliance on this bundle will start from December 1st 2010 with the completed months data submitted by the 8th of the following month by the health boards nominated project leads.
Enhanced Recovery after Surgery WebEx 1

11. How is the data to be collected….?
Data collection tool
Issued on/after Learning session 1
To start collecting data from December 1st 2010
Project leads for each organisation to submit a months completed data to Programme manager by the 8th the following month
Date collection tool- tool is ready for distribution. This will be issued just after LS1. Tool is Excel spreadsheet data collection tool. It will demonstrated at LS1 by developer Lisa Williams on how to use it. Tool will then be made available to each site after this event.
Data collection- each site to start collecting bundle compliance from 1st December 2010.
Submission of data- Project leads for each organisation to submit a months completed data to Programme manager by the 8th the following month
Enhanced Recovery after Surgery WebEx 1

12. Data capture tool Enhanced Recovery after Surgery WebEx 1
This is a screen image of the data capture tool. This will be available on the day of learning session 1, if project leads can bring memory sticks we can transfer a copy on to this otherwise we will follow this up with an with the tool attached.
Enhanced Recovery after Surgery WebEx 1

13. Dates for your diary…. Learning sessions 17th November 2010
11th January 2011
7th April 2011
WebEx calls
17th January 2011
28th February 2011
4th April 2011
9th May 2011
13th June 2011
These are the agreed dates of forthcoming calls and learning sessions for ERAS. Content of these sessions will be available ASAP
Enhanced Recovery after Surgery WebEx 1

14. Contact information for ERAS
Mel Baker (Programme Manager)
Rachael Barlow (Clinical Lead)
ERAS 1000 Lives Webpage
Contact details for myself and Rachael.
ERAS webpage- keep an eye out on the ERAS webpage. New developments on the site coming soon, but there are links to sites of interest, presentations, news and progress reports to access now.
Enhanced Recovery after Surgery WebEx 1

15. Any Questions???
Enhanced Recovery after Surgery WebEx 1