The Effectiveness of the Enhanced Recovery Programme for Category 4 Elective Caesarean Sections within Brighton and Sussex University Hospitals

2017 ◽  
Vol 14 (4) ◽  
Author(s):  
Olivia Shaw
Keyword(s):  
Enhanced Recovery ◽  
University Hospitals ◽  
Enhanced Recovery Programme

scholarly journals Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hakim Harkouk ◽  
Perrine Capmas ◽  
Nawal Derridj ◽  
Anissa Belbachir ◽  
Lionelle Nkam ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Application Rate ◽  
University Hospitals ◽  
Top Down ◽  
Enhanced Recovery Programme ◽  
Massive Open Online Course ◽  
Application Rates ◽  
Control Intervention ◽  
Before And After ◽  
Total Knee

Abstract Background Enhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP). Methods A retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy and hysterectomy) in 17 hospitals including 29 surgical departments. Data were collected in one control intervention (total hip arthroplasty (THA), gastrectomy and ovariectomy). In 2016, Massive Open Online Course on ERP and a day meeting information were developed by APHP. A national update on ERP was also organized by HAS and a regional professional partnership programme was started. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients’ chart and in anaesthetist and surgeon interview. Seventy percent application rate reflects application of ERP procedure. Results 1321 patient’s files were analysed (812 in 2015 and 509 in 2017). The LOS (mean (SD)) is reduced by 1.6 day for TKA (2015, 8.7 (6.7) versus 7.1 (3.4) in 2017; p<0.001) but stable for colectomy and hysterectomy. Incidence of severe complications after surgery is unchanged in all types of surgical models. For TKA and hysterectomy respectively applied items of ERP (i.e. >70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. The mean application rates of ERP items stayed below 50% in all cases in 2017. The LOS was negatively correlated with ERP items’ application when data collected in 2015 and 2017 were analysed together. Conclusion ERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach.

scholarly journals Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

2011 ◽  
Vol 93 (6) ◽  
pp. 451-459 ◽  
Author(s):  
PG Vaughan-Shaw ◽  
AT King ◽  
T Cheung ◽  
NE Beck ◽  
JS Knight ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Median Duration ◽  
Enhanced Recovery ◽  
Neoadjuvant Treatment ◽  
Abdominoperineal Excision ◽  
Short Term ◽  
Invasive Approach ◽  
Enhanced Recovery Programme ◽  
Duration Of Surgery

INTRODUCTION Conventional abdominoperineal excision for low rectal cancer has a higher local recurrence and reduced survival compared to anterior resection. An extralevator abdominoperineal excision (ELAPE) may improve outcome through removal of increased tissue in the distal rectum. Experience with ELAPE is limited and no studies have reported on quality of life (QOL) following this procedure. We describe a minimally invasive approach to ELAPE within an enhanced recovery programme, and present short-term results and QOL analyses. METHODS All laparoscopic ELAPEs were included in a prospective database. Demographics, intra-operative and post-operative outcomes were evaluated. Postoperative QOL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and QLQ-CR29. RESULTS Thirteen laparoscopic ELAPEs were performed over a two-year period. All were enrolled in an enhanced recovery programme. The median age was 76. The median tumour height was 20mm (range: 0–50mm) from the dentate line and all patients received neoadjuvant treatment. The median duration of surgery was 300 minutes (range: 120–488 minutes), the mean blood loss was 150ml and one procedure was converted to open surgery. There was no circumferential resection margin involvement or tumour perforation. The median duration of use of intravenous fluid, patient controlled analgesia and urinary catheterisation was 2, 2 and 2.5 days respectively and the median length of hospital stay was 7.5 days. Two patients developed perineal wound dehiscence. QOL analysis revealed high global health status (90.8), physical (91.3), emotional (98.3) and social functioning (100) scores, which compared favourably with EORTC reference values and published QOL scores following conventional abdominoperineal excision. CONCLUSIONS Laparoscopic ELAPE within an enhanced recovery setting is a feasible and safe approach with acceptable short-term outcomes and post-operative quality of life.

scholarly journals Many small steps to reducing length of stay: A visit to the DH pilot enhanced recovery scheme

2010 ◽  
Vol 92 (8) ◽  
pp. 266-268
Author(s):  
Matthew Worrall
Keyword(s):  
Length Of Stay ◽  
Health Service ◽  
Patient Experience ◽  
Enhanced Recovery ◽  
Enhanced Recovery Programme ◽  
Department Of Health ◽  
Recovery Scheme ◽  
Hospital Stays ◽  
Improve Patient

Enhanced recovery (ER) is one of the current buzz terms in the health service but it seems to mean a different thing depending on to whom you speak. The Department of Health (DH) invited applications from acute trusts across England to become 'innovation sites' for the enhanced recovery programme. These sites are supported by DH as they implement a defined programme that aims to improve patient experience through shorter hospital stays. The Bulletin spent a day at one of them, West Hertfordshire Hospitals NHS Trust, to witness the changes made.

scholarly journals The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection

2017 ◽  
Vol 21 (4) ◽  
pp. 614-621 ◽  
Author(s):  
Timothy J. Underwood ◽  
◽  
F. Noble ◽  
N. Madhusudan ◽  
D. Sharland ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery Programme ◽  
Development Application

Determinants of outcome after colorectal resection within an enhanced recovery programme

2009 ◽  
Vol 96 (2) ◽  
pp. 197-205 ◽  
Author(s):  
P. O. Hendry ◽  
J. Hausel ◽  
J. Nygren ◽  
K. Lassen ◽  
C. H. C. Dejong ◽  
...  
Keyword(s):  
Colorectal Resection ◽  
Enhanced Recovery ◽  
Enhanced Recovery Programme

Perioperative fluid therapy in elective colectomy in an enhanced recovery programme

2012 ◽  
Vol 82 (7-8) ◽  
pp. 535-540 ◽  
Author(s):  
Sanket Srinivasa ◽  
Simran P. Singh ◽  
Arman Adam Kahokehr ◽  
Matthew H. G. Taylor ◽  
Andrew G. Hill
Keyword(s):  
Fluid Therapy ◽  
Enhanced Recovery ◽  
Enhanced Recovery Programme ◽  
Elective Colectomy ◽  
Perioperative Fluid Therapy
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