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Enhanced recovery pathways and the need to link with primary care

2010 February 3
by webmaster

Are you doing enough to involve and engage with primary care clinicians when introducing enhanced recovery pathways?

To date, the literature which describes enhanced recovery programs has tended to focus on how best to optimise the pre-operative and in-patient management of patients. This is largely because the decision to introduce enhanced recovery pathways has been driven by clinicians working within hospitals (secondary care), and not by primary care clinicians who work in the community, and who manage the care of patients before referral and after discharge following their surgery.

However, as we know, patients do not divide their care into primary and secondary care episodes, for them the journey as a patient is a continuous one, which can often start with pain many years before surgery, and may continue for up to 1-2 years post-operatively. With this in mind, if the aim of enhanced recovery is to optimise every step of the patients’ pathway it would seem essential to ensure that the enhanced recovery pathways adopted within hospitals are part of a larger integrated pathway running from primary to secondary, and then back to primary care.

When introducing an enhanced recovery pathway how will you ensure that health professionals working in the community are able to deliver a consistent message to patients, are aware of the different procedures within the hospital, and understand the reduced length of hospital stay that these patients will have. There are may possibilities, but having the resources to get the message to such a wide network of people such as GP’s, practice nurses, physiotherapists, community nurses, and home help facilities will be challenging.

Getting representatives from these groups involved at the first stages of planning a new pathway is ideal, but this will need to be supplemented with ongoing dialogue, update, and communication about the outcomes of the pathway.

At a recent education event we took the opportunity to update a group of physiotherapists from Hampshire, Dorset and Somerset on the principles of enhanced recovery. Before we started the session we asked them to complete a survey, and whilst the sample size of 40 was not huge it can be considered representative. Of interest was that only 25% of the physiotherapists had previously heard of the concept of enhanced recovery. This may not be surprising given that relatively few units are using enhanced recovery pathways at present, but it does highlight the general need to increase the profile and awareness of enhanced recovery amongst health professionals. This is especially important given the Department of Health’s plan to encourage the widespread role out of enhanced recovery pathways in the coming months.

How are you engaging with your primary care providers? What difficulties or successes have you had? If you work in primary care and already working with enhanced recovery pathways, what are you doing to integrate your services with those of secondary care?

Please post a comment to share your experiences, and recommend this blog to interested colleagues.

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