Enhanced Recovery Getting Started.  Introductions  Housekeeping  Objectives for the session

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Text of Enhanced Recovery Getting Started.  Introductions  Housekeeping  Objectives for the session

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Enhanced Recovery Getting Started Slide 2 Introductions Housekeeping Objectives for the session Slide 3 This Session Practical activities to get you started Based on the Implementation Guide Access to advice, guidance and support Discuss the key elements of your local implementation plan Slide 4 Overview This Session: Principles, elements and benefits of ERP Drivers for Implementation Current and future pathway Action Planning: Stakeholder Analysis Testing changes for improvement Measuring Outcomes Slide 5 Principles, elements and benefits of Enhanced Recovery Slide 6 What is it? Enhanced Recovery is a new way of improving the experience and well-being of patients who need major surgery It helps people to recover sooner so that life can return to normal as quickly as possible It gives people a better overall experience due to higher quality care and services It lets people choose whats best for them throughout the course of their treatment with help from their GP and the wider healthcare team (No decision about me without me.) Many people who have experienced Enhanced Recovery say that it makes a hospital stay much less stressful Your Better Sooner!!! Slide 7 The Principles of ER Getting the patient in to the best possible condition for surgery Ensuring the patient has the best possible management during their operation Ensuring the patient has the best post- operative rehabilitation Slide 8 Kehlets theory 1980s Slide 9 9 Referral from Primary Care Pre- Operative Admission Intra- Operative Post- Operative Follow Up Optimised health / medical condition Informed decision making Pre operative health & risk assessment - CPEX PT information and expectation managed DX planning (EDD) Minimally invasive surgery Use of transverse incisions No NG tube (bowel surgery) Use of LA with sedation Epidural management (inc thoracic) Optimised fluid management 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 opiate- based analgesia where possible or administered topically Optimised Fluid Hydration Reduced starvation No / reduced bowel preparation ( bowel surgery) DX on planned day Therapy support (stoma, physio) 24hr telephone follow up Optimising pre operative haemoglobin levels Managing pre existing co morbidities e.g. diabetes Audit & outcome measures Example of ER elements Slide 10 Physical impact Slide 11 Clinical evidence compelling! Slide 12 Colorectal Surgery: Length of stay Large Intestine: Major Procedures Slide 13 Benefits being realised... Slide 14 Multi-Disciplinary Teams? It give patients a better overall experience through higher quality care and services It introduces innovative best practices that empower and motivate staff It accelerates the clinical decision-making process by empowering MDTs It doesnt increase MDT workload It ensures the most-efficient use of healthcare resources Best-practice is day surgery or an Enhanced Recovery pathway Slide 15 What does it mean for providers? It improves patient safety and involvement and meets Care Quality Commission requirements It reduces demand on resources such as critical care, surgical beds and patient uptake of procedures It increases job satisfaction of Multi-disciplinary Teams through better ways of working and improved patient outcomes It improves the reputation of the healthcare provider Best-practice is day surgery or an Enhanced Recovery pathway Slide 16 Process & capacity impact Slide 17 Commissioners? It enhances the reputation of the healthcare provider It helps patients recover sooner from surgery Best-practice is day surgery or an Enhanced Recovery pathway It improves patient experiences through increased partnership and empowerment (No decision about me without me.) It motivates medical teams through best practice, empowerment and innovation It reduces demand on resources such as critical care, surgical beds and patient uptake of procedures Slide 18 Trusts with varying experience of enhanced recovery pathways North East Gateshead NHS Foundation Trust (M) Newcastle Hospitals NHS Trust (C) City Hospitals Sunderland NHS Foundation Trust (U) Northumbira NHS Trust (MSK) South Tees Hospitals NHS Foundation Trust (C,G,U) North West Aintree University Hospitals NHS Foundation Trust (M) East Lancashire Hospitals NHS Trust (C) Hope Hospital, Salford (C) Wirral University Teaching Hospital NHS Foundation Trust (C)(M) Aintree University Hospitals NHS Foundation Trust (C,M,UPGI,Li) Yorkshire & The Humber Sheffield Teaching Hospitals NHS Foundation Trust (G) York Hospitals NHS Foundation Trust (C) Scarborough Healthcare NHS Trust (C) Leeds Teaching Hospitals NHS Trust (C,G) Calderdale and Huddersfield NHS Foundation Trust (C,G) West Midlands City Hospital NHS Trust, Birmingham (C) Good Hope Hospital (C) University Hospitals Birmingham NHS Foundation Trust (C) Birmingham Heartlands NHS Trust (C)University Hospital of North Staffordshire NHS Trust (C,U,G) Robert Jones & Agnes Hunt NHS Trust East Midlands Derby Hospitals NHS Foundation Trust (G) Queens Medical Centre (C) Sherwood Forest Hospitals NHS Foundation Trust (C) (G) The University Hospitals of Leicester NHS Trust (C,M,G,U) East of England Colchester Hospital University NHS Foundation Trust (C) West Suffolk Hospital NHS Trust (M) Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital)(G) West Hertfordshire Hospitals NHS Trust (C,M,G,U) South East Coast Brighton and Sussex University Hospital NHS Trust (C) Darent Valley Hospital (Dartford and Gravesham NHS Trust) (M) Royal Surrey County Hospital NHS Trust (C) Worthing Hospital (C) East Kent Hospitals University NHS Foundation Trust (Queen Elizabeth, the Queen Mother Hospitals)(G) Medway NHS Foundation Trust(C) Medway NHS Foundation Trust (C,M,G,U) Brighton and Sussex University Hospitals (C,M,G,U) London Barnet & Chase Farm Hospitals NHS Trust (C) Guys & St Thomas NHS Foundation Trust (C) Hillingdon Hospital NHS Trust (M) Imperial College Healthcare NHS Trust (C) South West London Elective Orthopaedic Centre (M) St Georges Healthcare NHS Trust (C)(U) St Marks Hospital (North West London Hospitals NHS Trust) (C) The Whittington NHS Trust (C) (M) UCLH NHS Foundation Trust (C) Whipps Cross University Hospital NHS Trust (C) The Hillingdon Hospital NHS Trust (C,G) North Middlesex University Hospital NHS Trust (C,M,G) South West North Devon Healthcare NHS Trust (C) South Devon Healthcare NHS Foundation Trust (C)(M)(G) Royal Devon and Exeter NHS Foundation Trust (U) Royal Bournemouth Hospital (M) North Bristol NHS Trust (Southmead Hospital)(U) Yeovil District Hospital NHS Foundation Trust (C)(M) Salisbury NHS Foundation Trust (C) Dorset County Hospital NHS Foundation Trust (C) Plymouth Hospitals NHS Trust (C) West Dorset NHS Trust (C) South Devon Healthcare NHS Foundation Trust (Torbay Hospital) (C,M,G,U) South Central Isle of Wight Healthcare NHS Trust (C) Milton Keynes Hospital NHS Foundation Trust (C) Royal Berkshire NHS Foundation Trust (C) Portsmouth Hospitals NHS Trust (C) Southampton University Hospitals NHS Trust (C) Oxford Ratcliffe(C) NHHT M)Winchester & Eastleigh NHS Trust (C,M,G) Royal Berkshire NHS Foundation Trust (C,M,G,U) Legend The following denotes a trust is working in this specialty: (M) Musculoskeletal (C) Colorectal (U) Urology (G) Gynaecology Enhanced Recovery Innovation Sites are shown in red Scotland NHS Lothian (M) Gold Jubilee National Hospital (M) Slide 19 Drivers for Implementation Bella Talwar Slide 20 Implementation Plan 1.Understanding your current service 2.Team working 3.Action planning 4.Stakeholder analysis 5.Stakeholder engagement 6.Testing and making changes to your pathway Understanding the risks 7.Understanding the investment required 8.Maintaining momentum 9.Sustaining the change Slide 21 Slide 22 Audience: Patients Enhanced Recovery is a new way of improving the experience and well-being of patients who need major surgery. It helps people to recover sooner so that life can return to normal as quickly as possible It gives people a better overall experience due to higher quality care and services It lets people choose whats best for them throughout the course of their treatment with help from their GP and the wider healthcare team (No decision about me without me.) Many people who have experienced Enhanced Recovery say that it makes a hospital stay much less stressful Slide 23 Enhanced Recovery is a new, evidence-based pathway that creates fitter, patients who recover faster from major surgery It give patients a better overall experience through higher quality care and services It introduces innovative best practices that empower and motivate staff It accelerates the clinical decision-making process by empowering MDTs It doesnt increase MDT workload It ensures the most-efficient use of healthcare resources Best-practice is day surgery or an Enhanced Recovery pathway Audience: Multi-Disciplinary Teams Slide 24 Mapping your pathway against the Enhanced Recovery Elements Bella Talwar Slide 25 Understanding your current service Identify elements in place on enhanced recovery pathway map Audit of compliance with clinical elements on an individual patient basis Process map / Walk the patient journey Track patient journeys Patient Experience Length of Stay Re-operation rates Readmission rates Complication rates CLINICAL INTERVENTIONSCLINICAL SYSTEM OUTCOMES Slide 26 Understanding your current service Referral from Primary Care Pre- Operative Admission Intra- Operative Post- Operative Follow Up 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 Minimally invasive surgery Use of transverse in