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Making Waves October 07 - James Paget University Hospitals

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Enhanced recovery after surgery<br />

(ERAS) or fast track surgery<br />

Roshan Lal and Jerome Pereira, Consultant General Surgeons at the Trust are currently developing<br />

a new patient care pathway for colorectal and breast patients. <strong>Making</strong> <strong>Waves</strong> caught up with<br />

them to find out more about this new programme that will have real benefits for patients.<br />

Roshan Lal Jerome Pereira<br />

Enhanced Recovery<br />

Programme after Surgery<br />

(ERAS) or Fast Track<br />

Surgery is a multi<br />

disciplinary approach to<br />

patient care. This<br />

pathway takes a patient’s<br />

perspective from start to<br />

finish. Detailed<br />

information about the treatment plan, pain control and the<br />

patient before, during and after hospital treatment is<br />

considered. Mr Roshan Lal explains; ‘ERAS involves fine<br />

tuning conventional clinical practice and careful coordination<br />

of everyone involved in the patient’s care’.<br />

Key factors in ERAS are:<br />

• patient information<br />

• pre operative assessment, avoiding bowel preparation<br />

• modern intra operative anaesthesia (fluid restriction,<br />

minimal physiological disturbance)<br />

• use of minimal invasive surgical techniques<br />

• reduced use of drains and tubes<br />

• prevention of complications<br />

• effective dynamic pain control (by using epidural and<br />

morphine sparing pain treatment)<br />

• early mobilisation<br />

• early oral nutrition<br />

• active involvement of the patient.<br />

Most of these are relevant for patients undergoing<br />

colorectal operations. To deliver this requires the active<br />

involvement and support of nurses, physiotherapists,<br />

anaesthesiologist, dieticians and surgeons.<br />

Mr Lal continues: ‘ERAS is mainly for ASA 1, 2 and fit ASA<br />

3 patients undergoing elective bowel surgery. Discharge,<br />

although achieved early, has the same discharge criteria as<br />

for patients treated in conventional way.’<br />

Patients are given detailed information leaflet covering all<br />

areas of their care. In case of any ‘warning signs’, for<br />

example, inadequate pain control, wound problems, signs or<br />

symptoms suggestive of anastomotic leak, patients are<br />

advised to seek help from their GP or to attend A&E.<br />

Experience from other centres has observed a 10 to 20%<br />

readmission rate in the beginning for medical and social<br />

reasons. Most of these hospital visits are for minor problems<br />

not requiring a hospital stay.<br />

Mr Lal finished by saying: ‘Published results from various<br />

centres in the UK and abroad suggest significant and clear<br />

overall benefits for patients. This approach leads to better<br />

surgical outcomes, reduced complication rates (systemic<br />

morbidity), earlier recovery, a short inpatient stay and better<br />

utilisation of health care resources. In the long term it‘s<br />

envisaged that there will be 30 to 40 % reduction in hospital<br />

stay for most patients.‘<br />

‘Results of our initial six months experience will be<br />

audited and presented at the various forums in the Trust, and<br />

published through <strong>Making</strong> <strong>Waves</strong>.’<br />

Look back at 2006/<strong>07</strong><br />

The Trust’s Annual Report and Summary Review of the Year<br />

have just been published. The lighter style of the summary<br />

aims to give staff and<br />

patients alike a flavour of<br />

our achievements last year.<br />

And much quicker to read<br />

than the Annual Report<br />

too! This has been really<br />

well received by<br />

everyone, and will be<br />

used as a handout at<br />

Membership recruitment<br />

events, and also in<br />

recruitment packs for<br />

new staff. It shows<br />

everyone how much we<br />

have achieved as a<br />

Trust in the last twelve<br />

months.<br />

Farewell to Dr Forster<br />

Dr Peter Forster, Consultant Physician, retired from the Trust<br />

on 8th June, with over 20 years service. Bernard Brett and<br />

Nigel Huston gave speeches at the event where friends and<br />

colleagues gathered to say their farewells. As a<br />

parting gift, Dr Forster was presented with an<br />

English longbow, pictured. Dr Forster is a keen<br />

fan of archery and several ‘Robin Hood’<br />

references were made! Dr Forster was<br />

looking forward to enjoying his<br />

retirement, sailing on his boat and<br />

planned visits to France<br />

and Spain.<br />

www.jpaget.nhs.uk<br />

<strong>October</strong> 20<strong>07</strong> <strong>Making</strong> <strong>Waves</strong> 3

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