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Surgery patients encouraged to ‘get well, sooner’ by being involved in their recovery

25 July 2012

A method of helping patients ‘get well, sooner’ after major surgery at Derby Hospitals NHS Foundation Trust is now officially launched, aiming to minimise the impact of surgery and significantly reduce the time spent in hospital.

Enhanced Recovery After Surgery (ERAS) is designed to encourage patients to take control of their own care and be a part of their operation, rather than just have a procedure ‘done to them’. Clinicians and nursing staff create an environment which helps patients to be fully involved in their care and to be motivated to get better more quickly.

This has led to a series of improvements in patient care after major surgery including reduced length of hospital stay, reduced complications and improved patient experience. Because length of stay is reduced, it also provides better value for the NHS.

ERAS sets out the four key actions that patients can take to play their part in a quicker recovery from surgery – rest, eating healthily, staying active and cutting down on smoking and drinking alcohol – as well as the changes to practice made by clinical staff. It is now available to patients having orthopaedic, gynaecological, urology/Upper GI and colorectal surgery.

The scheme has been piloted and showed a reduction in the average length of stay from:

Gynaecology cancer surgery
Length of stay has gone from 5.2 days to 2.6 days. In addition the service – which has seen approximately 200 patients under ERAS – saw lower than average re-admission rates, a reduction in post operative complications and patients reporting a more positive experience.

Orthopaedics
Under ERAS, patient length of stay for hip replacement and knee replacement operations has been reduced by one-three days, with median length of stay down to three nights from five nights. 40% of hip replacement patients stayed only one or two nights versus 10% before the pilot programme, while for knee replacement patients 30% stayed one or two nights versus 5% before the pilot programme.

Colorectal surgery
Length of stay reduced by two days to which reduced pain for patients and allowed them to eat, drink and mobilise sooner following surgery. Readmission rates fell from approximately 4.5% to 3%.

There are four elements to ERAS. The first is that pre-operative care is improved, through areas such as earlier assessments and planning and encouraging patients to get their bodies as fit as possible before the operation. Secondly, the physical stress of the operation is reduced, with best practice, minimally-invasive operation techniques (either smaller incisions or a laparoscopic approach), greater use of epidural local anaesthesia and, simply, keeping patients warmer during the operation.

Post operative comfort is improved, with the focus on getting patients moving and eating normally as soon as possible after their operation. Post-operative pain is 'vigorously treated' to reduce surgical stress responses, while getting patients on the move and back to their normal diet as quickly as possible is encouraged. 

Finally, the focus of continuing post-operative care is on continuing to manage post-operative pain, maintaining a strong focus on nutrition and mobilisation and ensuring clear discharge and post-discharge arrangements are in place.

Dr Stuart Gold, consultant in anaesthesia at Derby Hospitals, said: “Enhanced Recovery After Surgery represents a significant improvement in patient care for those having major surgery. Derby Hospitals is embracing these principles and looks to be the first hospital to introduce this to all patients having major surgery. ERAS is not about sending patients home before they are ready; it is about helping them get better sooner. Patients are now specifically asking for it which demonstrates that the benefits are strong and clear.”
 
ERAS is based on the principles pioneered by Professor Henrik Kehlet in Denmark, which showed that by educating and motivating patients and surgical, anaesthetic, nursing and physiotherapy staff on the benefits of early feeding and mobilisation and an effective pain management regime, a significant reduction in length of hospital stay may be achieved. 

Sue James, chief executive of Derby Hospitals, said: “Enhanced Recovery is an excellent example of how hospital staff and patients can work together to really make a difference to patient care, ensuring patient comfort and wellbeing. Small changes to care can improve patient experience while reducing length of stay and complications.

“Patient feedback so far has been excellent, and we are closely monitoring surgery outcomes and complication information. The dedication of the teams involved has resulted in this project blossoming and including more and more specialties. It goes to show that improvements can be made that benefit both patients and the hospital.”

The materials to support this programme have been developed in partnership with Pfizer and include patient booklets by surgery, posters, ‘get well sooner’ cards & as part of the East Midlands HIEC project in ERAS an online learning programme.

David Bevan, head of specialty care at Pfizer UK, said: “Pfizer is committed to working closely with the NHS to identify effective ways to secure sustainable savings for the long-term, not only in order to achieve efficiency targets, but more importantly to improve patient outcomes through access to the right treatments and health services at the right time. This initiative with the Royal Derby Hospital is a clear demonstration of the results that can be achieved through collaborative working between industry and the NHS.”