Rehabilitation for Operated lung Cancer (ROC) programme
Amy Kerr (nee Bradley), Mr R. Steyn, Mr P.B. Rajesh, Mr M. Kalkat, Mr E. Bishay, Prof B. Naidu
Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
Category: Innovative Dissemination
INTRODUCTION
5000 patients in the UK undergo curative lung cancer surgery for
cancer. 15% of patients develop complications that are
associated with an increased risk of death, intensive care
admission, and hospital length of stay.
METHODS
The Rehabilitation for Operated Lung Cancer (ROC) programme is
a multi-faceted programme, designed to optimise fitness for lung
surgery, reduce incidence of complications, and support the
Enhanced Recovery After Surgery (ERAS) pathway. The ROC
programme includes four components: pulmonary rehabilitation,
smoking cessation support, dietary advice and patient education.
Components are widely available, but rarely utilised in this
patient group.
SPREADING THE PROGRAMME
Birmingham Heartlands hospital is the regional thoracic centre and
takes referrals from 12 hospitals. A number of strategies were
implemented to spread the programme outside the Trust, including:
• Document key steps required to set up the programme
• Identify local stakeholders for each referring hospital
• Use evidence of benefits gathered during testing to open up a dialogue
with local stakeholders
• Support setting up local rehabilitation programmes with training,
documentation and visits to the Thoracic ward at Heartlands
• Refine local pathways
• On-going measurement of improvements
• Development and distribution of ROC DVD for national spread
Press coverage of the programme has facilitated wider
dissemination
Patient and health care professional feedback of the 1000
DVDs distributed nationally has been excellent.
The DVD has won several national prizes.
DVD FEEDBACK FROM PATIENTS
For ipad
ROC: PUBLISHED DISSEMINATION
• NHS Improvement. ‘Fulfilling the Potential: A Better Journey for Patients
and a Better Deal for the NHS (Enhanced Recovery)’
http://www.improvement.nhs.uk/documents/er_better_journey.pdf
• Cancer Rehabilitation. ‘Making excellent cancer care possible’ National
cancer action team - national cancer programme (March 2013)
• Pulmonary rehabilitation programme for patients undergoing curative lung
cancer surgery. Eur J Cardiothorac Surg. 2013;44(4):e266- 71.
QR
CODE
TRY OUT THE NEW ROC ‘APP’
ONGOING IMPROVEMENT
Initial results were disseminated locally and at key national
meetings to enable ROC programme adoption in other hospitals
throughout the UK.
OUTCOMES
Implementation of the programme reduced the incidence of
post-operative pulmonary complications by 7% (16% to 9%).
Hospital readmissions due to surgical complications fell by 9%
(14% to 5%)
There was also a reduction in ITU admissions and measurable
cost savings.
SCAN HERE TO SEE PATIENT VIDEO
FEEBACK ABOUT THE ROC PROGRAMME
CONCLUSIONS
• Patient optimisation prior to surgery improves outcomes.
• Patient education and information are cornerstones of good
surgical practice.
• Centres across the UK have adopted the ROC programme, and are
using the DVD to facilitate this.
• Roc now has recognised as a example of good practice in national
enhanced recovery guidelines
• An ‘APP’ is now been developed to facilitate wider dissemination.
“Excellent, very informative and able to prepare for surgery
better”
Was it useful? “Yes, definitely, it told me what I needed to know
and also do the exercises, cause I only went to one class before
surgery”
“It was all useful, could not be improved.”
“I think my breathing has improved since doing the exercises.”
DVD FEEDBACK FROM CARERS
“Although it made me cry, I was really glad I watched it. I feel I
can understand what my Mum will go through.”
“I watched on behalf of my mother. The information given helped
me a lot to understand what she was facing and how it was going
to be done.”
DVD FEEDBACK FROM ALLIED HEALTH PROFESSIONALS
“I think it gives them a better resource than verbal or written info
and the use of real people to watch is more appropriate.
Preparation at home in this way is more helpful”
CONTACT DETAILS:: amy.kerr@heartofengland.nhs.uk