Enhanced Recovery Innovation sites Workshop 3

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Enhanced Recovery Innovation sitesWorkshop 3
Professor Monty Mythen National Clinical Lead
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The Enhanced RecoveryPartnership Programmes aim

• To improve the quality of patients care, through
  improving their clinical outcomes and experience,
  and reduce the length of elective care inpatient
  pathways across the NHS by utilising the good
  practice principles of enhanced recovery models
  of care.

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Enhanced Recovery

• A new approach to elective surgery
• Applications to colorectal, orthopaedic, gynae
  and urological surgery (and probably other areas)
• Different preoperative, perioperative and
  postoperative care
• Good evidence base though need to develop
  further
• Clinical champions
• Potential to improve quality and reduce bed days
  (e.g. colorectal 13 ? 6 days)
• Challenge To implement enhanced recovery
  across England within 2 years

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Example of Enhanced Recovery elements

• Optimising pre operative haemoglobin levels
• Managing pre existing co morbidities e.g. diabetes

• Admission on day
• Optimised Fluid Hydration
• CHO Loading
• Reduced starvation
• No / reduced oral bowel preparation ( bowel
  surgery)

Referral from Primary Care

• Planned mobilisation
• Rapid hydration nourishment
• Appropriate IV therapy
• No wound drains
• No NG (bowel surgery)
• Catheters removed early
• Regular oral analgesia
• Paracetamol and NSAIDS
• Avoidance of systemic opiate-based analgesia
  where possible or administered topically

Pre- Operative
Admission

• Optimised health / medical condition
• Informed decision making
• Pre operative health risk assessment
• PT information and expectation managed
• DX planning (EDD)
• Pre-operative therapy instruction as appropriate

Intra- Operative

• Minimally invasive surgery
• Use of transverse incisions (abdominal)
• No NG tube (bowel surgery)
• Use of regional / LA with sedation
• Epidural management (inc thoracic)
• Optimised fluid management Individualised goal
  directed fluid therapy

Post- Operative

• DX on planned day
• Therapy support (stoma, physio)
• 24hr telephone follow up

Follow Up
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National programme
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Enhanced Recovery Innovation Sites Programme
Key Milestones
2010
2009
Mar
Feb
Jan
Dec
Nov
Oct
Sept
Aug
3) 27/10 Workshop - Detailed sessions on
elements of ER , informed decision making,
optimising pre operative health state, Specialty
specific aspects. Change management and service
Improvement methodologies, sustainability
1) 23rd Sept Workshop General Principles,
overview project planning
2) Project plan Team established including
baseline measurement and preparation work
Establish Local Project preparation
5) 17/12 Workshopprogress from sites, specialist
issues workshops, sustainability, technology
innovation, ,one to clinic sessions
4) prep work, identify patient groups,
communications to wider team, engage pt user
groups, testing measuring
Separate sessions will also be held for
Executive Directors and Primary Care in addition
to this but alongside existing forums.
7 Workshop Requested sessions, benchmarking
progress associated learning, planning
2010/2011 local spread sustainability strategy
Preparation, testing, measuring, feedback
6) Evaluation of ERPP to central team
recommendations for future
measurement will continue beyond March 10 for
up to 12 months, this will support local
sustainability and contribute to impact analysis
Refine / implement /Measure / Mainstream /
sustain
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Important change to workshop 4!

• Changed the date from 4th Feb 2010 to March 24th
• 11 -12 weeks notice
• Rationale
• more time to embed change
• more time for data collection / build up the
  evidence
• Site / LHC presentations feedback on progress

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Support for 2010/11

• National spread programme
• General launch events to raise awareness for all
  Trusts and PCTS
• 25th February 2010 (Newcastle)
• 17th March (north / midlands)
• 31st March London
• Innovation sites will be asked to support / share
  experience and recommendations in their regions
• Further support to innovation sites ( x 2
  meetings June October 2010) for innovation sites

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Objectives for the day

• Further exploration of key principles of Enhanced
  Recovery
• Guest speakers, including Roy Lilley public
  speaker on radio and television on current health
  affairs
• Clinical, Nursing and Allied Health Professionals
  group breakout sessions, focussing on support and
  sustainability using sustainability guide
• Investment and benefits
• Open clinic / surgeries where teams can re visit
  their own challenges with the experienced speakers

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Enhanced Recovery Partnership Programme
Innovation Sites Training Day
Jury's Inn Birmingham Hotel, 245 Broad Street,
Birmingham, B1 2HQ17th December 2009, 0945-1630
0900-0945 - Registration and refreshments 0945
1015 - Chairs welcome Professor Monty Mythen
National Clinical Lead Update on progress
and implementation guide - Mr Alan Horgan,
National Clinical Lead - 1015 1115 Change in
the NHS, Keeping the pace Mr Roy Lilley,
Previous NHS CEO, and public speaker on health
affairs
1115 1145 Coffee 1145 1315 Clinical
Surgeries Opportunity to work with the
speakers, discuss progress and your key
challenges sceptics welcome! 1315 1415
Lunch
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Enhanced Recovery Partnership Programme
Innovation Sites Training Day
Jury's Inn Birmingham Hotel, 245 Broad Street,
Birmingham, B1 2HQ17th December 2009, 0945-1630
1415 1430 Investments cost benefits Ann
Driver NHS Improvement Director 1430 1450
Planning and delivering a sustainable project
Ms Kate Hall NHS Institute Innovation and
Improvement 1450 - 1510 Coffee
1510 Breakout session 2 assessing your
sustainability considerations of quality and
productivity. (Groups by Trusts). 1630 Close
within groups
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