System-wide implementation of ERAS plus in Greater Manchester
Loveridge, R. Nethercott, D. Moore, C. Darwin, L. Ekambaram, R. Faulkner, G. Allen, Jonathan Forrest, C. Moore, J.
Loveridge, R.
Nethercott, D.
Moore, C.
Darwin, L.
Ekambaram, R.
Faulkner, G.
Allen, Jonathan
Forrest, C.
Moore, J.
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Abstract
With the damaging impact of COVID-19 on elective surgery globally, it is vital that we delivermajor surgical care that supports patients, minimises complications and reduces hospital lengthof stay (LOS). Enhanced Recovery After Surgery (ERAS) processes [1] provide a means of doingthis and the UK ERAS+ peri-operative pathway (www.erasplus.co.uk), which includes a particularemphasis on patient preparation using the surgery school education tool and pre-habilitationelements, has been shown in a single centre to reduce peri-operative pulmonary complications(PPC) and improve hospital LOS [2]. MethodsIn 2017, ERAS+ Greater Manchester (GM), was awarded Health Foundation Scaling Up fundingfor the implementation of ERAS+ in six NHS hospitals across GM. Beginning in January 2018,quality improvement and operational partners alongside an expert ERAS+ team worked withsite teams in two overlapping phases (three hospitals in each) to support the integration ofERAS+ into colorectal surgical oncological pathways in all six sites, and ERAS+ into lung andupper GI cancer surgical oncological pathways in two of the hospitals. The site ERAS+ teamconsisted of peri-operative anaesthetist, surgeon, ERAS nurse, allied health professionals and ahealth foundation funded data audit clerk.ResultsFig. 1 shows the results of aggregate LOS data for colorectal cancer resection surgery for ?veof the hospital sites (A, C, D, E and F), which undertook ERAS+ from 2018 onwards (no. ofpatients = 1328) and for which Trust historical LOS data were available. The completion pointsfor the initial two phases of implementation of ERAS+ are demonstrated. For the ?ve-sitesshown, the baseline mean LOS was 12.1 days. There was an aggregate reduction in LOS to9.0 days, a reduction of 3.1 days, associated with a reduction in PPC. Patient measured satisfac-tion with ERAS+ was excellent and there was no increase in re-admission rates associated withLOS reduction. Factorial design methodology was used to compare combinations of processmeasures patients received against LOS. Generally, a lower LOS occurred where patients (1)were mobilised within 24 h post-surgery, (2) started an oral diet within 24 h after surgery and(3) attended Surgery School before admission. DiscussionERAS+ has been implemented successfully at a system level in GM for colorectal cancerpatients, with an aggregate LOS reduction of over 3 days, which was associated with reducedrate of PPC.
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Date
2021
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Citation
Loveridge R, Nethercott D, Moore C, Darwin L, Ekambaram R, Faulkner G, et al. System-wide implementation of ERAS plus in Greater Manchester. Anaesthesia. 2021;76:21-.