Enhanced recovery – a better journey for patients and better deal for the NHS Sue Cottle
Sue Cottle, Improvement Manager at NHS Improving Quality, explains that Enhanced Recovery care pathways are about providing consistent safe care to patients across the whole healthcare system, to enable patients to get better sooner. Over the next three to five years, NHS England and NHS Improving Quality (NHS IQ), will work in partnership to help deliver Seven Day Services that people need.
Patients and the public deserve the same standards of care seven days a week to enable them to get better sooner and return back to their everyday lives. Enhanced Recovery is not about performing elective surgery seven days a week, it’s about ensuring that the same standard of care is delivered consistently across the whole health system to improve outcomes and experience for patients.
Enhanced Recovery is not only about acute elective surgical hospital care but is also about emergency care. More and more on my travels across acute hospitals in England, I hear clinicians say ‘Enhanced Recovery? We do that’. But are we really, and how well do we do it?
Ask yourself, is your organisation delivering Enhanced Recovery care pathways across the whole health system to provide the same standard of care seven days a week? How have you applied Enhanced Recovery principles to emergency care pathways such as laparotomies, trauma, maternity care, acute medicine?
The NHS seven day service standards, announced by Professor Bruce Keogh, Medical Director NHS England, will go some way to get organisations to think about how they might adopt the principles of Enhanced Recovery beyond elective surgery.
Enhanced Recovery pathways are about the whole system working together to improve patient outcomes. Recovery starts way before you get to hospital. Pathways start by optimising patients conditions prior to hospital admission. This may be primary care getting someone as fit as they can be at home prior to surgery, ambulance staff preparing patients prior to emergency admission, or social and community care effectively planning to enable recovery at home. All are key components of Enhanced Recovery pathways. It is not the individual part but all of these parts that will provide safer care seven days a week.
We therefore need to engage with patients and the public, organisations and professionals across the whole healthcare care system and continuously monitor the effectiveness of Enhanced Recovery care pathways, to ensure we deliver the same standard of care seven days a week.
We know that Enhanced Recovery is evidence based and is benefiting many patients beyond colorectal, urology, gynaecology and musculoskeletal elective surgery to other specialties. The Heart of England Foundation Trust provides us with an excellent example of how therapy staff work across the whole pathway to not only provide pre-habilitation programmes to optimise patients’ condition prior to lung surgery, but also provide rehabilitation post-operatively by ensuring the same therapy service provision seven days a week.
Sheffield Teaching Hospital NHS Trust provide a practical example of how women undergoing elective caesarean section can now go home safely the next day if feasible, with community midwives visiting the next day.
I’ve also found that emergency medicine have started to embrace the principles of Enhanced Recovery. Early evidence shows that many of the Enhanced Recovery principles apply just as well to medicine, as other specialties. Torbay hospital at South Devon Heatlhcare NHS Foundation Trust is one of the Trusts leading the way in this area.
Come and find out more about the Seven Day Service Improvement Programme and Enhanced Recovery Levels of ambition 2014/5 [hyperlink to ] by joining our session, Enhanced Recovery Care Pathways: A better Journey for Patients Seven Days a Week and a better deal for the NHS at EXPO on 4 March 2014 at 12.00hrs, Room 5 Pop up university.