Enhanced Recovery in medicine


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Enhanced Recovery in medicine
Ben Benjamin
Torbay Hospital
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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Enhanced Recovery in medicine

  1. 1. Enhanced recovery in medicine Ben Benjamin Torbay Hospital
  2. 2. Why are you in hospital? patient doctor nurse notes 20% agreed on reason!
  3. 3. Hypothesis If patients are given more information about the expected process of recovery and involved in the decision-making process they will recover more quickly, feel safer, be more satisfied with the care they receive and go home earlier.
  4. 4. Enhanced recovery elements identified •optimise pre operative haemoglobin levels •manage pre existing co morbidities e.g. diabetes Referral from Primary Care PreOperative Getting you home; swiftly and safely •admit on day of surgery •optimised fluid hydration •CHO Loading •reduced starvation •no / reduced oral bowel preparation ( bowel surgery) Admission •optimise health / medical condition •informed decision making •pre-operative health & risk assessment •patient information and expectation managed •discharge planning (EDD) •pre-operative therapy instruction as appropriate •minimally invasive surgery •use of transverse incisions (abdominal) •no NG tube (bowel surgery) •regional / LA with sedation •epidural management (inc thoracic) •optimise fluid management •individualised goal directed fluid therapy •planned mobilisation •rapid hydration & nourishment •appropriate IV therapy •no wound drains •no NG (bowel surgery) •catheters removed early •regular oral analgesia •paracetamol and NSAIDS •avoid systemic opiatebased analgesia where possible or administered topically IntraOperative PostOperative •discharge when criteria met •therapy support (stoma, physio) •24hr telephone follow up Follow Up
  5. 5. What can we learn from enhanced recovery in surgery? • Unable to influence pre-hospital state • Can give appropriate fluids, nutrition, exercise • Can involve patients in process of recovery
  6. 6. What is the relevance to medicine? • acute illness is ‘stress’ just like an operation • simple adherence to fluid, nutrition & mobilisation plus information are key and could be applied to all inpatients?
  7. 7. Getting you home; safely and at the right time Daily target setting Energy drink Day clothes, no PJs Mobilisation Decision-making between the patient, medical team and families/carers Oral fluids Plan transport early
  8. 8. Pre-hospital • Information from GPs, Ambulance crew, carers • Patient’s clothes in bag
  9. 9. Mobilisation • • • • • Get dressed! (no flappy gowns) Avoid catheters (consider leg bag) Is a monitor really necessary? Is a drip really needed? Drip-free mornings
  10. 10. Clothes • The MAU is not a bedroom!
  11. 11. Clothes • Bring in own clothes • Supply of outdoor clothes (?laundry)
  12. 12. Fluids Drip-free mornings
  13. 13. Energy drinks • 10 am drinks round – now ER round • Energy drink station for ambulant patients
  14. 14. Involvement of patients and carers • Encourage carers and relatives to be involved (problems with visiting times)
  15. 15. Communication • • • • Posters Video ER motivation sessions – nurses/therapists Talks to carers
  16. 16. Insert Pt leaflet
  17. 17. Benefits To improve patient and carer experience. To reduce readmission rates. To reduce length of stay.
  18. 18. Measurement • • • • • Patient experience interviews. LoS data. Survival rates. Beddays used by patients on ER Readmission rates. Run charts – • getting dressed by 10am • Drip-free mornings • Number of energy drinks consumed
  19. 19. Next steps • Testing the process, approach and methodology continues for patients admitted on MAU. • Rolling out to other medical wards. • Involving patients and carers in the redesign plans. • Involving academic partners to help us measure effect – new PhD student with Exeter Business School!
  20. 20. Summary In Torbay hospital we are testing the hypothesis that patient involvement in the recovery process from acute medical illness will result in more rapid recovery, earlier discharge and greater patient satisfaction. We have developed a multidisciplinary approach, based on enhanced recovery principles, which encourages patients to achieve the goals necessary to get home more quickly and safely
  21. 21. • Look at video – Torbay Hospital Thanks to Managers: Jane Dewar, Debbie Honeywill, Andrew Fordyce Nurses: Erica Dunn, Nicki Joyce, Sue Bramwell Carer lead: Stephen Black OT: Becky Brixton