Transcript Impact of information

ENHANCED RECOVERY:
Fulfilling the potential
a better journey for patients
a better deal for the NHS
Wendy Lewis
Programme Manager
© 2012 AQuA
ER is the standard pathway for all patients
© 2012 AQuA
2
Royal College endorsement
‘We believe that Enhanced
Recovery should now be
considered as standard
practice for most patients
undergoing major surgery
across a range of
procedures and specialties.’
ER is the norm - are you doing it?
“We believe that enhanced recovery should now be considered as standard
practice for most patients undergoing major surgery across a range of
procedures and specialties”.
Aligned to the NHS Outcomes Framework
ER is “big cog” in a whole pathway
“Enhanced Recovery is a solid platform to build upon, ER is
a strong concept and we have the opportunity to widen this
further along the care pathway and continue to generate
evidence of its impact”
Professor Keith Willet
Good progress has been made
LOS: Hip, Knee, Hysterectomy, Prostatectomy
(Quarterly HES data)
6.5
Falling length of stay
6.0
5.0
70,000 fewer bed days
No increase in re-admissions
Hip
4.5
Knee
4.0
Ab Hyst
3.5
Vag Hyst
3.0
Prostatectomy
2.5
2.0
% Compliance with ER Components: May-July 2012
(All specialties, except where indicated. Source: ER National Toolkit: Sample size 3,972)
Reductions in
complications
Pre Op Visit
Pre-op
Patient Assessed for Surgery
Patient Explanation ERP
Therapy Education Given (MSK)
Stoma Education Given (Col)
Oral Bowel Prep Avoided (Col)
Patient Admitted on Day of Surgery
Carbohydrates Given
Avoidance of Sedatives
Intra-op
Increasing compliance
with
Individual components
Antibiotics Prior
Epidural or Regional Analgesia
Individual Fluid Therapy
Hypothermia Prevention
Avoid Abdominal Drains (Col)
NG Tube Removed
Post-op
Length of Episode
5.5
Avoid Crystalloid Overload
Avoid Systemic Opiates
Post-Op Nutritian
Nausea and Vomiting Control
Early Mobilisation
0%
20%
40%
60%
80%
100%
Impact of information
My Roles and My Responsibilities
‘It was very comforting to know what was expected
of me each day and to think that I could manage
it too.’ Patient
‘Patients have a better understanding of their need
to engage in their own roles and responsibilities.
It has prompted them to ask more questions.’
Health Professional
Potential for spreading is huge
Spreading across more specialties: A best practice care pathway with a compelling
evidence base.
Excision of lung
Hospital Episodes Statistics, provisional 2012-13 Apr-Sep
14.0
12.0
Mean LOS
10.0
8.0
6.0
4.0
2.0
0.0
0
50
100
150
200
No of cases
250
300
350
We know the job is not done …………………
But it’s a job worth doing
The Future
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Widely publish outcomes to Clinical Commissioning Groups
Widen clinical engagement e.g. primary/social care
Include ER in standard commissioning contracts
ER is central to development of Best practice tariffs
Strategic clinical networks and clinical senates are key in
championing and enabling ER
For further information:
http://www.improvement.nhs.uk/enhancedrecovery/