enhanced recovery

Enhanced Recovery: 5 Years On
Professor Michael (Monty) G Mythen
Lecture Abstract : 2014 Conference

The document ‘Delivering Enhanced Recovery – Helping Patients to Get Better Sooner After Surgery’ was published by the UK Department of Health Enhanced Recovery Partnership Program on March 10th 2010[1].  The forward says: 

‘Enhanced recovery is transforming NHS elective and cancer care pathways by using a number of evidence based interventions as a model of care enabling patients to recover sooner following surgery. This guide, developed using learning from centres across the UK, provides a starting point to support implementation of enhanced recovery.’ 

By November 2013, a progress review entitled ‘Enhanced Recovery Care Pathway’ reported successful National implementation in four main types of elective surgery – colorectal, gynaecology, orthopaedics and urology[2].  Thousands more surgeries were being performed in 170,000 fewer bed days. Target lengths of stay had been achieved, readmission rates had not increased, and both quality and patient satisfaction had improved [2,3]. A win-win-win-win.  That document includes a copy of a consensus statement signed by 17 of the UK’s health care leaders including the NHS Medical Director and Presidents of the Royal Colleges of Anaesthetists, Medicine and Surgery that concludes:

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

In May 2012 at a national ‘summit’, the success of the English Enhanced Recovery Partnership Program was celebrated and the consensus statement signed*[3]. However, this celebration was of the successful start of a journey and by no means the completion of one. There is still much to be done in our system and the ambition has recently been documented to include continued progress in the initial four areas, spread to all elective surgeries, development and implementation in emergency surgery and medical pathways[3]

The Royal College of Anaesthetists believes that there is a role for us to step up to this challenge and drive Perioperative Medicine as a significant part of the solution. Perioperative medicine is already within anaesthesia and many of us have implemented perioperative solutions, particularly around pre assessment and enhanced recovery. I have been asked by our President, to lead a Task & Finish Group and to develop this programme of work over the next 1-3 years.

The RCoA, multi-disciplinary Task & Finish Group will: 

  1. Present the RCoA as the relevant body of expertise to lead the delivery of the major elements of perioperative care 
  2. Set and develop existing standards and design services for this perioperative care
  3. Deliver a training programme which reflects the broad role of the Perioperative Physician, in line with the recommendations of the Shape of Training report
  4. Embed continuous quality improvement into the care of our surgical patients through a joined up perioperative care pathway.
  5. It is anticipated that from the establishment of these areas of work in the next three years to maturity may take 10-15 years.  Working together, we aim to build on the components of the enhanced recovery programme to ensure an improved perioperative approach to healthcare delivery for all.

References (also available via: www.enhancedrecovery.uk)

  1. Delivering  Enhanced Recovery – helping patients to get better sooner after surgery. 
  2. Enhanced Recovery Care Pathway- a better journey for patients seven days a week: Progress review (2012-13) and level of ambition (2014/15). 
  3. Fulfilling the Journey – a better deal for patients a better deal for the NHS.