NHS England National Perspective – Enhanced
Recovery Care Pathways: a better journey for
patients seven days a week and be...
Aligned to the NHS Outcomes Framework

ER is “big cog” in a whole
pathway
“Enhanced Recovery is a solid
platform to build ...
Progress and level of ambition
• Quality is the driving
principle
• Key components – 5 P’s
• Good progress made
• Extend p...
Progress: ER is becoming the norm
“We believe that
enhanced recovery
should now be
considered as standard
practice for mos...
ER is about simple steps
to get patients
better sooner
Good progress has been made:
A patient centred approach
• Patient involvement
and shared decision
making at the heart of
E...
92%

89%

86%
78%

74%

Progress: ER improves patients experience
……………………………… patients get better sooner
Patient Experien...
Progress: ER reduces length of hospital stay
Falling length of stay
70,000 fewer bed days

Increasing day of surgery
admis...
Progress: ER increases day of surgery admission
Increasing day of surgery
admissions

No change in readmissions
We know the Job is not done
…………………
But it’s a job worth doing
We know the Job is not done - variation exists
Variation in
- spread and adoption to other
elective surgical procedures
- ...
Obstetrics: Elective C - Section
Summary and future levels of ambition
• Increase patient engagement to empower
patients
• Ensure all patients get the same...
Orthopaedic:
Hip and knee replacement
Colorectal:
Colectomy and excision rectum
Urology:
Prostatectomy and Cystectomy
Gynaecology: Hysterectomy
Other surgical specialties
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NHS England National Perspective – Enhanced Recovery

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NHS England National Perspective – Enhanced Recovery Care Pathways: a better journey for patients seven days a week and better deal for the NHS
Dr Celia Ingham Clark,
National Clinical Director for Enhanced Recovery and Acute Surgery, NHS England
Presentation from Shaping the Future Direction of Enhanced Recovery Care Pathway Seven Days a Week workshop held in London on 5 December 2013

Published in: Health & Medicine
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NHS England National Perspective – Enhanced Recovery

  1. 1. NHS England National Perspective – Enhanced Recovery Care Pathways: a better journey for patients seven days a week and better deal for the NHS Celia Ingham Clark, National Clinical Director for Enhanced Recovery and Acute Surgery, NHS England
  2. 2. 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 Willett
  3. 3. Progress and level of ambition • Quality is the driving principle • Key components – 5 P’s • Good progress made • Extend principles of ER beyond elective practice • Integrate ER across the whole system
  4. 4. Progress: ER is becoming the norm “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”.
  5. 5. ER is about simple steps to get patients better sooner
  6. 6. Good progress has been made: A patient centred approach • Patient involvement and shared decision making at the heart of ER Designed by patients for patients • The potency of patient involvement helps to drive spread and adoption of ER
  7. 7. 92% 89% 86% 78% 74% Progress: ER improves patients experience ……………………………… patients get better sooner Patient Experience: Enhanced Recovery compared to National Inpatient Survey 1 94% 86% 0.9 0.8 95% 92% 78% 89% 84% 74% 0.7 0.6 0.5 0.4 0.3 0.2 as much as you How much information about Did you feel you were involved in Did hospita t your0.1 care and your condition or treatment was decisions about your discharge contact if y ent? 0 given to you? from hospital? your condi Were you involved as much as you How much information about Did you feel you were involved in Did hospital staff tell you who to yo wanted to be about your care and your condition or treatment was decisions about your discharge contact if you were worried about treatment? given to you? 2011-Enhanced Recovery 2011-Enhanced Recovery from hospital? your condition or treatment after you left hospital? 2010-National Inpatient Survey - elective only 2010-National Inpatient Survey - elective only
  8. 8. Progress: ER reduces length of hospital stay Falling length of stay 70,000 fewer bed days Increasing day of surgery admissions No increase in readmissions
  9. 9. Progress: ER increases day of surgery admission Increasing day of surgery admissions No change in readmissions
  10. 10. We know the Job is not done ………………… But it’s a job worth doing
  11. 11. We know the Job is not done - variation exists Variation in - spread and adoption to other elective surgical procedures - momentum of spread in existing procedures Early testing in - emergency and acute medical - maternity pathways
  12. 12. Obstetrics: Elective C - Section
  13. 13. Summary and future levels of ambition • Increase patient engagement to empower patients • Ensure all patients get the same standard of care seven days a week – spread to non-elective care • Develop systems to optimise patients fitness for referral and risk stratification to improve patient safety • Develop internationally comparable outcome measures to further build the evidence 13
  14. 14. Orthopaedic: Hip and knee replacement
  15. 15. Colorectal: Colectomy and excision rectum
  16. 16. Urology: Prostatectomy and Cystectomy
  17. 17. Gynaecology: Hysterectomy
  18. 18. Other surgical specialties
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