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The core principles of enhanced recovery

2010 January 15
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by webmaster

Having looked at the literature and case studies which detail enhanced recovery pathways, the following characteristics typify enhanced recovery across the surgical specialties.

Pre-operative

  • Thorough pre-operative intervention to optimise health and medical condition
  • Management of patient expectation through pre-operative education and counselling
  • Organisation of discharge arrangements

Intra-operative

  • Atraumatic and minimally invasive surgical techniques
  • Shortened surgical times
  • Optimised anaesthesia – usually regional anaesthetic techniques with light sedation
  • Promotion of normovolemia, normothermia and prevention of hypoxia

Post-operative

  • Early physiotherapy intervention and promotion of ambulation
  • Regular and effective analgesia with avoidance of opiates where possible
  • Rapid introduction of normal hydration and feeding
  • Promotion of a “wellness” model of care – catheter, drains and drips are removed as soon as possible, and independence with washing, dressing and socialisation is promoted.

Discharge

  • Patients are discharged home
  • Criteria-based discharge protocol managed by the multi-disciplinary team
  • Patients have clear instructions on how to progress rehabilitation independently

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3 Responses
  1. Barbara Dougan permalink
    June 14, 2010

    I am interested in finding out more about how you followed up patients pain assessments- At Melbourne conference R Middleton described sending patients home with a device post operatively that patients could use daily to provide electronic feedback re pain assessment. Could you please provide more information about the technical side as well as how you used the information- sound like a great way of maintaining patient centeredness.

    Thanks barbara

  2. webmaster permalink*
    March 5, 2010

    Hi Pamela,
    Thanks for your comment. I agree, there will be differences in motivation level between individual patients post-operatively.
    There will always be the patients who are highly self-motivated, but the key is to help those patients who need extra encouragement to exercise and progress their rehabilitation. This is where an enhanced recovery pathway can help. In the exemplar units (which use an enhanced recovery pathway) the increased educational input pre-operatively helps patients to understand the importance of rehabilitation post-op and the likely timelines involved. When patients are in hospital the high level of physiotherapy input reinforces this, and then patients are supported post-discharge with follow up phone calls, out-patient physiotherapy, exercise DVD’s and booklets.
    Best wishes, Tom

  3. Pamela permalink
    March 3, 2010

    thanks for this blog – very useful indeed.
    reading through the core principles I question whether hte last
    “Patients have clear instructions on how to progress rehabilitation independently” is sufficient.
    From talking with professionals involved in hip replacements I get the strong impression that instructions alone aren’t motivating people to undertake physio.
    Wondered what you’re thoughts are

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