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New publication from the Enhanced Recovery Partnership – We talk about enhanced recovery for fractured neck of femur patients

2012 May 8
by webmaster

Here is a link to the recently published NHS Improvement guide

Enhanced Recovery Partnership: Fulfilling the potential. A better journey for patients and a better deal for the NHS.

It’s 60 plus pages of great information from across the surgical specialties which has been prepared jointly by the Department of Health, NHS Improvement, National Cancer Action Team, Advancing Quality Alliance, National Enhanced Recovery Clinical Leads and Advisors, NHS Improvement Associates, SHA Enhanced Recovery Leads and Patient Advisors.

We were asked to write the Musculoskeletal update which we share below.

Applying enhanced recovery to trauma procedures in musculoskeletal surgery leads to highly significant improvements to quality of care and productivity To date, the focus within orthopaedics has been on implementing enhanced recovery to hip and knee joint replacement pathways.

The Enhanced Recovery Partnership Programme helped to; raise the profile of enhanced recovery within orthopaedics, increase the evidence base for it’s implementation, engage multi-disciplinary teams and key stakeholders, and create some important drivers for change . Consequently, the results achieved by pioneering sites have been replicated widely across the country, and a national reduction to average LOS with high levels of patient experience has been achieved.

However, whilst the results for hip and knee replacement patients are encouraging, two key challenges remain if we are to further improve patient outcomes and significantly increase hospital productivity throughout the country. The first challenge is that more work is required to support the adoption of enhanced recovery as the standard practice for all hip and knee replacement patients across all units. This is because there remains evidence of considerable variation in outcomes, such as case-mix adjusted length of stay across units, and also variations in pathway content, with non-adoption of recognised enhanced recovery steps in some units.

Secondly, the challenge for hospitals that have successfully implemented enhanced recovery for hip and knee replacement patients is for them to apply the same principles to other orthopaedic procedures. Importantly, this work should not be limited to elective surgery, especially given that exemplar units are now reporting excellent results when implementing enhanced recovery pathways for their fractured neck of femur patients.

For example, at Poole Hospital, LOS has reduced and the number of patients discharged home has increased following the introduction of enhanced recovery principles. The average LOS at Poole for fractured neck of femur patients is now 12 days which is 9.3 days lower than expected for their case-mix and 8 days less than the national average of 20 days . They are further applying the principles of enhanced recovery in orthopaedic trauma, and have significantly increased the number of trauma procedures completed as day surgery over the last 2 years . This has improved both patient experience and improved efficiency. This success is not in isolation; other sites such as Torbay are also reporting reduced LOS for fractured neck of femur patients following the implementation of enhanced recovery.

The potential impact, if this work in fractured neck of femur is replicated across the country is highly significant. This is because of the high volumes of fractured neck of femurs that occur annually (There were 62,453 inpatient spells in 2011) and the current variations in LOS and mortality rates. Whilst implementing enhanced recovery within trauma surgery will present different challenges, the factors that have underpinned success in hip and knee replacement such as strong clinical and managerial leadership, a multi-disciplinary team approach, a standardised pathway, and a highly organised logistical framework, remain the same.

We therefore propose that the immediate focus of our efforts should be not only to ensure the spread of enhanced recovery through elective care, but more importantly to improve clinical outcomes and patient experience for our most vulnerable patients such as those with a fractured neck of femur. It is here that we will have the biggest impact on improving the quality of care for patients, and the potential for productivity gains across the country is highly significant.


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