NHS England National Perspective – Enhanced Recovery Care Pathways: a better journey for

patients seven days a week and better deal for the NHS

Celia Ingham Clark, National Clinical Director for Enhanced Recovery

and Acute Surgery, NHS England

Aligned to the NHS Outcomes Framework

ER is “big cog” in a whole pathway

“Enhanced Recovery is a solid platform to build upon, ER is a strong concept and we have the opportunity to widen this further along the care pathway and continue to generate evidence of its impact”

Professor Keith Willett

Progress and level of ambition• Quality is the driving

principle• Key components – 5 P’s• Good progress made• Extend principles of ER

beyond elective practice

• Integrate ER across the whole system

“We believe that enhanced recovery should now be considered as standard practice for most patients undergoing major surgery across a range of procedures and specialties”.

Progress: ER is becoming the norm

ER is about simple steps to get patients

better sooner

Designed by patients for patients

• Patient involvement and shared decision making at the heart of ER

• The potency of patient involvement helps to drive spread and adoption of ER

Good progress has been made: A patient centred approach

94% 92% 89%95%

78%

86%

74%

84%

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Were you involved as much as you wanted to be about your care and

treatment?

How much information about your condition or treatment was

given to you?

Did you feel you were involved in decisions about your discharge

from hospital?

Did hospital staff tell you who to contact if you were worried about your condition or treatment after

you left hospital?

Patient Experience: Enhanced Recovery compared to National Inpatient Survey

2011-Enhanced Recovery 2010-National Inpatient Survey - elective only

94% 92% 89%95%

78%

86%

74%

84%

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Were you involved as much as you wanted to be about your care and

treatment?

How much information about your condition or treatment was

given to you?

Did you feel you were involved in decisions about your discharge

from hospital?

Did hospital staff tell you who to contact if you were worried about your condition or treatment after

you left hospital?

Patient Experience: Enhanced Recovery compared to National Inpatient Survey

2011-Enhanced Recovery 2010-National Inpatient Survey - elective only

Progress: ER improves patients experience ……………………………… patients get better sooner

Falling length of stay

70,000 fewer bed days

Increasing day of surgery admissions

No increase in readmissions

Progress: ER reduces length of hospital stay

Progress: ER increases day of surgery admission

Increasing day of surgery admissions

No change in readmissions

We know the Job is not done ………………… But it’s a job worth doing

We know the Job is not done - variation exists

Variation in- spread and adoption to

other elective surgical procedures - momentum of spread in existing procedures

Early testing in- emergency and acute

medical- maternity pathways

Obstetrics: Elective C - Section

Summary and future levels of ambition • Increase patient engagement to empower

patients• Ensure all patients get the same standard of care

seven days a week – spread to non-elective care• Develop systems to optimise patients fitness for

referral and risk stratification to improve patient safety

• Develop internationally comparable outcome measures to further build the evidence

13

Orthopaedic: Hip and knee replacement

Colorectal: Colectomy and excision rectum

Urology: Prostatectomy and Cystectomy

Gynaecology: Hysterectomy

Other surgical specialties