Last month (October) the 20,000 Days ERAS (Enhanced Recovery After Surgery) Collaborative Team, which consists of doctors, nurses, anaesthetists, allied health, decision support, cultural support, ERAS Project Manager and Improvement Advisor) were awarded a *Health Roundtable Innovation Award for their work in reducing the length of stay for elective patients undergoing primary knee and hip replacements.
Established 6 months ago, as part of the 20,000 Days Campaign, the ERAS team has been looking at ways of increasing the number of surgical patients going through the ERAS pathway to reduce length of stay, without increasing re-admissions and improving patient satisfaction. To put it simply they want patients to get better quickly, go home sooner and come back less often.
So far the team’s work with elective primary hip and knee patients is showing great results with average length of stay going from 6½ days to 5½ days – that’s a saving of 588 bed days since March 2012. This is due to a number of factors which include: involving patients in Occupational Therapy pre-operative assessment, education and preparation, getting the patient out of bed and mobilising soon after surgery and aiming to remove all tubes from a patient within 48 hours of their operation. It’s a nurse-led approach which is making a difference.
Dr Andrew Hill, Professor of Surgery and his team were the first to introduce ERAS at Counties Manukau Health, piloting the programme in 2005 on patients undergoing bowel surgery at MSC. The results were favourable and showed a reduced length of stay, less complications, a significant cost saving and a better overall experience. We are delighted to say that Counties Manukau Health is now the national lead for this initiative, which has recently been rolled out to other DHBs in New Zealand.
“Following on from the work of Dr Hill, we are now using the ERAS programme to spread this methodology further with a key focus on the entire patient journey from pre-op education to earlier discharge,” says Ian Hutchby, Improvement Advisor.
Before patients come into Hospital they are provided with information that walks them through their day to day journey while in Hospital. This helps to set expectations from the very beginning and means patients and their families are able to visualise and prepare for what’s ahead.
Daily goals are also helping staff to track their patient’s progress and identify patients early that may need more input.
“We are still learning as we go, but we are heading in the right direction,” says Ian. “Our aim is to eventually spread the ERAS programme to other areas and meet the aims of the 20,000 Days Campaign which is to reduce the demand on our hospital, decrease readmissions and keep people well and healthy in our community.”
*The Health Round Table Innovation Awards on October 11-12 provided a forum for people working in healthcare organisation in Australia and NZ to share issues and innovations with each other.
Receiving innovation awards from Counties Manukau Health were the 20,000 Days ERAS Team and SMOOTH (Safer Medicines Outcomes on Transfer Home). Both programmes were chosen for their ability to be used and/or adapted to other areas.