Enhanced recovery is a modern, evidence-based approach that helps patients recover more quickly after having major surgery. Enhanced recovery is sometimes called “rapid” or “accelerated” recovery. And while we refer to it as a “pathway” (or ERP for short), you may come across the acronym ERAS, which simply stands for Enhanced Recovery After Surgery.
Many hospitals have enhanced recovery programmes in place and it’s now seen as standard practice following surgery for many procedures. At HDFT, we have introduced the pathways across our orthopaedic, gynaecology, maternity and colorectal services.
The pathway aims to ensure that patients:
- Are as healthy as possible before receiving treatment
- Receive the best possible care during their operation
- And receive the best possible care while recovering
Having an operation can be both physically and emotionally stressful. Enhanced recovery tries to get the patient back to full health quickly and safely. Research has shown that the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their recovery time will be.
In order to deliver this, our policy breaks the pathway down into six individual elements:
Referral from primary care
- At the point of referral, the patient’s GP is responsible for ensuring that the patient is as healthy as they can be ahead of surgery. Aside from routine review and management of co-morbidities such as diabetes or hypertension, they should also aim to optimise the patient’s haemoglobin levels.
Pre-operative
- This is the point at which we check that the patient is ready to undergo surgery. Health assessments, risks assessments and informed decision making underpin this stage of the pathway.
- For certain procedures, patients must attend an education class provided by our therapists, which will help in preparing you ahead of your operation.
- Additionally, patients are provided with information booklets.
Admission
- We usually admit the patient on the day of surgery.
Intra-operative
- As for the operation itself:
- Our surgeons always aim to use the least invasive surgical techniques. After all – the smaller the trauma, the easier it should be to recovery from.
- Our anaesthetists combine analgesia (pain control) and anaesthesia (sensation) to ensure that the patient is comfortable and safe, without resulting in prolonged grogginess or a lack of sensation afterwards.
Post-operative
- Patients will have been taught a series of physical exercises during the pre-op education class. These will vary depending upon the nature of the operation (for example, it won’t be the same exercises for the knee as the hip) but either way, they are very important and designed to get the patients on the road to recovery. We have also produced videos to demonstrate and guide individuals through the exercises:
Enhanced Recovery following Knee Replacement:
Knee exercises:
Enhanced Recovery following Hip Replacement:
Hip exercises:
Follow-up
- Finally, the patients should be ready for discharge.
- Patients will be discharged as soon as criteria are met.
- There may be additional therapy support, such as physio or dietetics.