Sophie Morris
Consultant Anaesthetist and lead for Colorectal
Enhanced Recovery, BSUH
Hannah Tompsett
Lead Nurse for Enhanced Recovery, BSUH
2nd July 2014
‘Enhanced recovery is a new,
evidence-based approach that helps
people recover more quickly after
having major surgery.’




Developed in Denmark in 1990s
Prof Henrik Kehlet
UK since 2002
Originally colorectal – now expanding into all
areas







Structured approach to whole patient pathway
Evidenced based approach
Patient as active participant in preparation
and recovery
Reduce physical stress of operation
Improve patient outcome
Doing the little things well
‘Aggregation of marginal gains’

Decreased length of stay:
◦ Colorectal: LOS reduced by mean1.15 days
 Nicholson A. Systematic review and meta-analysis of enhanced recovery
programmes in surgical patients. NIHR 2014

No increase in readmissions:
◦ Fractured NOF: Readmissions went from 6% to 2.3%
 Orthopaedic Rapid Improvement Programme – Delivering Quality and Value. NHS
Institute for Innovation and Improvement 2009

Reduction in complications:
◦ Open colorectal: 50% reduction in complications
 Varadhan K et al. The enhanced recovery after surgery pathway for patients
undergoing major elective open colorectal surgery: A meta-analysis of randomised
controlled trials. Clinical Nutrition 29 (2010) 434-440

Patient satisfaction:
◦ Gynae cancer: ‘Patients value information resources,
physio availability and follow up phone call’
 Archer S. et al. Exploring the experience of an enhanced recovery programme for
gynaecological cancer patients: a qualitative study. Perioperative Medicine 2014 3:2

Cost savings:
◦ DoH estimate savings to be between £35 - £52
million if implemented nationally when around 50
Trusts were doing so in 2009. (MSK, gynae,
colorectal, urology)
 DoH. Enhanced Recovery for Elective Surgery 2009.











GP involvement
Pre-op clinic
Optimise patient (HB, BP, Diabetes, Hydration)
Health promotion (Diet, smoking, exercise)
Involving and informing patient
Discharge planning – pt expectation
Patient information
Patient diary
Carbohydrate loading
No bowel prep
Avoid pre-meds











GP involvement
Pre-op clinic
Optimise patient (HB, BP, Diabetes, Hydration)
Health promotion (Diet, smoking, exercise)
Involving and informing patient
Discharge planning – pt expectation
Patient information
Patient diary
Carbohydrate loading
No bowel prep
Avoid pre-meds



4 cartons evening before surgery
2 cartons morning of surgery (before 6am)
Exclude patient groups:
◦ Diabetics on insulin
◦ Renal dialysis
◦ Severe cardiac failure on fluid restriction

Best served cold!

Ensuring the patient is fully informed

Revision of patient information leaflets

Introduction of DVD

Introduction of patient webpage
Established (CQUINs):
 Gynaecology
 Orthopaedics
 Colorectal
New Pathways
 Emergency (Laparotomy & #NOF)
 Obstetrics
 Breast
 Urology
 Upper GI
‘Same standard of care 7 days a week’

Introduction of SAU
◦ Clinical Pathways
◦ Ambulatory Care
◦ Readmission Pathway

Site Reconfiguration
◦ #NOF PRH
◦ Neurology services to RSCH

Introduction of Nurse Practitioners
◦ ERP Nurse for Ortho
◦ Nurse Prescribers
www.bsuh.nhs.uk/departments/enhancedrecovery-programme-erp/
http://nww.bsuh.nhs.uk/clinical/teams-anddepartments/trust-wide-teams/enhancedrecovery-programme-erp/
For further information please contact
Email: hannah.tompsett@bsuh.nhs.uk
Mobile: 07788567689