20 April 2018
BRI leads the way in enhanced recovery for thoracic surgery
Bristol Royal Infirmary (BRI) is leading the way in enhanced
recovery to help patients to recover more quickly after chest
surgery.
The hospital was the first in the
country - and one of the first in the world - to offer enhanced
recovery for thoracic surgery.
And the work has been so successful
that now Tim Batchelor, a consultant thoracic surgeon, and Neil
Rasburn, a consultant anaesthetist, are authors for the newly
published international guidelines for enhanced recovery after
thoracic surgery, which is the surgical treatment of chest disease
such as lung cancer and collapsed lungs. Delegations from hospitals
in the UK and mainland Europe have also visited the BRI
to find out more about the work of Tim, Neil and
their colleagues.
Tim Batchelor and Neil
Rasburn
Enhanced recovery is a modern evidence-based approach to care
which aims to ensure patients are as healthy as
possible before surgery, receive the best care possible during
and after their operation and also have the best experience whilst
recovering.
Some of the principles of the enhanced recovery programme for
thoracic surgery include:
- Not asking patients to stop food and drink before surgery -
instead they are advised to have a high energy drink two hours
before an operation, the equivalent of carbohydrate loading before
a marathon
- Having a minimally invasive or "keyhole" operation
- Encouraging patients to get up and moving soon after surgery
and walking around the ward
- Using as few tubes, drips and drains as possible
- Giving patients an expected date of discharge (EDD) so they
know what day they will be going home.
Tim said: "Patients are at the heart of our enhanced recovery
programme for thoracic surgery which has so many benefits from
helping patients to recover more quickly to reducing the risk of
infections, complications and loss of muscle strength."
Tim and Neil, along with nursing, medical and physiotherapy
colleagues, introduced an enhanced recovery programme for thoracic
surgery at University Hospitals Bristol NHS Foundation Trust, which
runs the BRI, in 2010.
Neil said: "Enhanced recovery is about looking at each
individual part of a patient pathway and making multiple small
improvements that benefit the patient and help them to recover more
quickly.
"We ensure our patients know what day they will be leaving
hospital as this helps them to get in the mind set of going home
and as soon as possible after surgery we encourage them to get out
of bed and start moving.
"Research shows that the earlier a patient gets out of bed and
starts walking, eating and drinking after an operation, the shorter
their recovery time will be."
Brenda Riney, from Congresbury, had enhanced recovery thoracic
surgery at the BRI on 5 February 2018 after a lump was found on her
lung. She returned home two days later on her expected date of
discharge.
The 67-year-old great-grandmother said: "Everything has been
excellent from the beginning. Everything has been thoroughly
explained to me, it was really helpful to know what day I would be
going home.
Brenda
Riney
"I was up and walking about four hours after having my surgery
and I couldn't have asked for a better experience. It's been
absolutely amazing."
Tim, who is the lead author of the international guidelines for
enhanced recovery in thoracic surgery published by the ERAS
Society, added: "Patients are empowered from the beginning when
they are referred to us as we provide all the information they need
and explain what enhanced recovery involves.
"The success of our thoracic surgery enhanced recovery
programme wouldn't have been possible without the involvement of
everyone on this patient pathway including pre-operative assessment
staff, ward nurses, physiotherapists, anaesthetists and
surgeons."
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