The Enhanced Recovery Programme is an evidence-based peri-operative form of care for surgical patients. It is intended to develop the fitness of patients and help them recover faster from surgery. The team reviewed existing obstacles by tracking patient’s daily experiences during their in-patient stay with a hand-held tablet ‘patient experience tracker’.
The main obstacles identified were the lack of pre-operative patient information and preparation, and post-operative management. Analgesia guidelines have been written to improve transitional analgesia, particularly once infusions end after 24-48 hours.
A six-month audit showed significant improvement and the patient experience project was repeated at 12 months. The median length of stay reduced from seven days to four for abdominal hysterectomy and daily well-being scores demonstrated an enhanced recovery.
Many patients do not recover as quickly or effectively from gynae-oncology surgery as they might. The team wanted to find out why this could be, and develop a protocol to help overcome the difficulties those patients experienced.
Several obstacles to enhanced recovery were identified in a pre-enhanced recovery programme. These were primarily a lack of pre-operative patient information and preparation; and shortcomings in post-operative management. The team wanted to identify the existing obstacles in our hospital from the patient’s point of view, rather than simply make its own judgements and assessment. This was done by tracking individual patient’s daily experiences during their entire in-patient stay with the innovative use of an electronic patient experience tracker (PET).
Such hand-held tablets are widely used to obtain one-off or individual patient experience or satisfaction data. The team, however, wanted to analyse the patient’s daily experiences throughout their hospital stay, to identify and analyse the problems that exist as the first step to eradicating them wherever possible, and thus make improvements in future hospital care and rates of recovery.
It was necessary to gather relevant, topical information from the experience of individual patients to guide us in identifying whatever factors there might be in place that were delaying their recovery after surgery. Once the team knew what these obstacles were, it followed that it would be necessary to modify our patient pathway and clinical practice to make it more patient-centric.
The essential element of this data gathering was that it would inform decision-making in developing a care pathway that would enhance the recovery of post-operative patients. This would lead to earlier discharge from hospital, allowing patients the preferable option of being able to recuperate at home – with appropriate clinical and other support as required.
A reduced length of hospital stay for patients, as has been widely documented elsewhere, will inevitably provide consequent efficiency savings. More importantly, as this is a patient-centric approach, it was essential that the people enjoyed as positive an in-patient experience as possible.
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