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NIHR Enhanced Recovery Report

2014 July 29
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NIHR

Thanks to Wendy Lewis (@ERPwend) for alerting us to this latest NIHR publication which is titled

“Initiatives to reduce length of stay in acute hospital settings: a rapid synthesis of evidence relating to enhanced recovery programmes”

A comprehensive summary concluding that there is consistent (albeit limited) evidence that enhanced recovery programmes may reduce length of patient hospital stay without increasing readmission rates in the NHS (it was mainly general surgery studies that were looked at and not orthopaedics).

They conclude that further single-centre RCTs are not a priority. Rather, what is needed is improved data collection and reporting of how enhanced recovery programmes are implemented, resourced and experienced in NHS settings.

Full reference here

Paton F, Chambers D, Wilson P, Eastwood A, Craig D, Fox D, et al. Initiatives to reduce length of stay in acute hospital settings: a rapid synthesis of evidence relating to enhanced recovery programmes. Health Serv Deliv Res 2014;2(21).

Enhanced Recovery after Fractured Neck of Femur – Poole results

2014 April 30
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Here are the slides from Rob Middleton’s presentation today at the Streamlining Pathways in Orthopaedic Trauma Care in Birmingham.



NHS Scotland – Orthopaedic Enhanced Recovery National Audit Results – 2013

2014 April 22
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NHS SCOT ERAS AUDIT

 

According to the audit results, over 90% of all hip and knee arthroplasty patients now benefit from an Enhanced Recovery pathway within NHS Scotland. Fantastic news – this audit shows the great progress made within Scotland over the last 3 years.

Download the full report here Enhanced Recovery Audit 2013 – Hip and Knee Arthroplasty

 

 

 

4th ERAS UK Conference

2014 April 22
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ERAS UK 2014

Please find information below about the 4th ERAS UK conference from Dr Fiona Carter on behalf of the ERAS UK Conference Organising Committee.

Preparations are well under way for the 4th ERAS UK Conference: “Expanding the Scope and Exploring the Journey” which will be held on Friday 14thNovember, at The Hub, City College, Southampton.  A flyer for this conference is attached and I would be grateful if you could share this information with any colleagues who may be interested in attending.

Thanks to those of you who have already submitted an abstract for the conference; the deadline for submission is 20th June 2014.  This year we would be particularly interested in work submitted in line with the main conference themes:

1. Exploring transitions of care including prehabilitation and post-discharge.
2. Examining advances in technology (for all disciplines related to enhanced recovery)
3. Measuring outcomes, including patient experience and data collection methods
4. Analyzing progress in non-elective and non-surgical pathways
5. Tackling the challenges of sustainability

There will also be a marketplace session for updates from different specialties and disciplines.

The reduced, early-bird registration will be available until 12th September 2014.  On-line registration and information about booking fees are available on our website:  www.erasuk.net

Download the flyer here ERAS UK 2014 flyer

 

 

Change Champions Masterclass 2014 Series – Australia and New Zealand

2014 March 31
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Rob MiddletonWe were recently invited to visit Australia and New Zealand to provide an update on Enhanced Recovery and also the conservative management of osteoarthritis. We enjoyed the trip and were fortunate to meet some great people doing brilliant work within the field. For those who attended here are some of the slides we used. Any questions, get in touch via the blog.

Thanks to Char and Diane at Change Champions for organising the trip.

www.changechampions.com.au

TW and RGM.







4th ERAS UK Conference: “Expanding the Scope and Exploring the Journey”

2014 February 14
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Enhanced Recovery

From Dr Fiona Carter, on behalf of the ERAS UK Steering Board….

4th ERAS UK Conference: “Expanding the Scope and Exploring the Journey”

Friday 14th November, The Hub, City College, Southampton

Registration and abstract submission is now open for this conference and we would be particularly interested in work submitted in line with the main conference themes:

1. Exploring transitions of care including prehabilitation and post-discharge.
2.  Examining advances in technology (for all disciplines related to enhanced recovery)
3. Measuring outcomes, including patient experience and data collection methods
4.  Analyzing progress in non-elective and non-surgical pathways
5. Tackling the challenges of sustainability

There will also be a marketplace session for updates from different specialties and disciplines.
The closing date for abstracts is 20th June and the deadline for early registration is 12th September.

Our website has had a makeover (www.erasuk.net) and I would be very keen to have your comments.

TW

 

The role of post-discharge physiotherapy following hip and knee replacement surgery

2014 February 4
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At last Friday’s Current Controversies in Orthopaedic Enhanced Recovery, David McDonald and I were asked to present the current case for and against post-discharge physiotherapy following hip and knee replacement surgery. Here are the slides for those who requested them.

In a lively session we hoped to stimulate debate and encourage our physiotherapy colleagues to give thought to their current and future practice.

As a profession we need to better understand the type, intensity, timing and combinations of exercise training and physiotherapy interventions that are most effective at improving function quicker and to higher levels in our patients.





 

Current Controversies in Orthopaedic Enhanced Recovery Conference – Glasgow

2013 December 23
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golden_jubilee_hospital_Current Controversies in Orthopaedic Enhanced Recovery

31st January 2014, Beardmore Hotel and Conference Centre, Glasgow, Scotland.

The day is designed to update all those involved in orthopaedic enhanced recovery about problem areas that we all recognise. It is anticipated that the talks and debate will further our understanding of the problems and help to standardise the solutions. The day is aimed at all professional groups involved in enhanced recovery who wish to update their understanding of the subject. Although this is primarily aimed at those involved within orthopaedics many of the topics will be common to other specialties and thus all interested professionals are welcome to attend.

Conference Programme

To reserve a place please complete the registration form and send it to Kirsty Quinn, Beardmore Centre for Health Science Administrator by email at health.science@gjnh.scot.nhs.uk.

Alternatively you can contact Kirsty on 0141 951 5910 for further information.

 

 

Enhanced Recovery Study Day – Maintaining Momentum. Salford Royal NHS Foundation Trust

2013 December 23
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NHS Salford Royal

What are you doing on 27th January 2014?

Join our colleagues at Salford Royal NHS Foundation Trust for an Enhanced Recovery Study Day.

The day will include varying presentations from the whole multidisciplinary team.

Including two workshops, one for orthopaedics and the other for Colorectal/Gynaecology/Urology.

“Enhanced Recovery Study Day – Maintaining Momentum”

The keynote speaker is Mr Mattias Soop.

Please see the programme below for full details and how to reserve a place.

NHS Salford Enhanced Recovery Study Day Programme

 

 

 

Orthopaedic Enhanced Recovery After Surgery (ERAS) – Taranaki District Health Board

2013 November 28
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In March 2012 we completed a series of Enhanced Recovery Masterclass education sessions in Australia and New Zealand.

In this blog post, Greg Sheffield from Taranaki District Health Board describes how he and his team implemented enhanced recovery after attending our Masterclass and visiting us in Bournemouth later that year. Well done to Greg and all of the team at Taranaki DHB!

Enter Greg….

“A working group was set up in July 2012 to look at the potential for ERAS principles to be applied to patients undergoing primary total hip (THR) and knee (TKR) replacements at Taranaki District Health Board (TDHB).

Taranaki

An initial review of our pathways identified several factors to work on:

  • Elective THR and TKR were our single biggest pathway
  • We had a 6.72 day average length of stay
  • We had multiple pathways for different orthopaedic surgeons
  • We lacked a structured joint replacement pathway across all specialties
  • We had an appreciation of inpatient costs in an increasingly challenging fiscal climate
  • Most importantly we wanted to improve patient experience and clinical outcomes

Having identified our challenges, the working group set about reviewing the latest literature and evidence from within New Zealand and overseas. As a result of this, we made a series of changes to our patient pathways – through pre-operative, intra-operative and post-operative phases. The key changes being:

Pre-operative

  • Introduced a nurse led triage service five months prior to surgery. This included robust screening and laboratory testing to help identify patients with comorbidities (e.g. anaemia, poorly controlled diabetes, hypo/hypertension) and instigate timely and appropriate onward referral
  • Consistent education regarding alcohol and smoking cessation
  • A GP ‘fit for listing’ health screening tool
  • Allied health screening tool. This helped to identify patient that would benefit from allied health input such as dietician input to manage malnutrition, physiotherapy to regain function or occupational therapy to provide home equipment
  • RAPT score – a tool used to predict patients likely to have an extended length of stay – was used to focus services on those patients most likely to benefit
  • A comprehensive, anaesthetist led, pre-operative  assessment aimed to provide clear and consistent information to aid patient decision making and informed consent
  • Pre-operative education class two weeks prior to surgery – detailing the patient journey through hospital and back home
  • Carbohydrate drink two hours before surgery to minimise dehydration and the impact of surgery

Intra-operative

  • Default regional anaesthesia +/- sedation
  • Standardised analgesic pathway
  • Minimising blood loss through the use of tranexamic acid and avoidance of surgical drains
  • Standardised prosthesis

Post-operative

  • Promotion of patient independence throughout
  • Early oral hydration and nutrition
  • Regular oral analgesia
  • Early removal of catheters and IV lines
  • Planned early and regular physiotherapy
  • Early return home
  • Strong ties to ongoing rehabilitation in the community

Managerial

  • Standardised multidisciplinary protocol
  • Re-developed critical pathway documents
  • New patient information booklets
  • Pre-printed medication charts
  • Analgesic pathway posters

The changes were trialled with one orthopaedic surgeon in January 2013, and rolled out to the remaining orthopaedic department in August 2013. Having implemented this raft of changes we achieved the following:

Taranaki LOS SPC

  • Average length of stay reduced from 6.72 days to 4.30 days
  • Average cost per patient reduced by 12%
  • Lower  re-admission and complication rates
  • Improved DOSA rates
  • High degrees of patient satisfaction

In October 2013, a national collaborative for Orthopaedic ERAS was launched by the New Zealand Ministry of Health, with a view to rolling out ERAS nationally by January 2015. We look forward to continuing our work on this project, and hope to achieve further successes yet.”

Greg Sheffield is Orthopaedic ERAS Project Manager and Clinical Lead in Musculoskeletal Physiotherapy at Taranaki District Health Board.