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

TRY OUT THE NEW ROC ‘APP’

SCAN HERE TO SEE PATIENT VIDEO FEEBACK ABOUT THE ROC PROGRAMME

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Press coverage of the programme has facilitated wider dissemination ONGOING IMPROVEMENT

Initial results were disseminated locally and at key national meetings to enable ROC programme adoption in other hospitals throughout the UK.

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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.

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.

For ipad

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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.

Patient and health care professional feedback of the 1000 DVDs distributed nationally has been excellent.

The DVD has won several national prizes

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DVD FEEDBACK FROM PATIENTS

“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”

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