Kevin McGee

Winter 2014
GP Connect
News from ELHT
@EastLancsHosp
EastLancashireHospitals
This is the second issue of GP Connect - the quarterly newsletter for GPs in East Lancashire. Highlights
in this issue include improved waiting times for both A&E and elective care; the chance to meet our
new intake of junior doctors, a round-up of news plus service developments and updates.
Please get in touch if there are specific topics you’d like us to include in forthcoming issues or if you’d
like to know more about the topics covered in this one, please contact Associate Medical Director Alan
Crowther via email [email protected].
A message from Kevin McGee, Chief Executive
I joined East Lancashire Hospitals NHS Trust in
September and I’m really pleased to have this
opportunity of being in touch with you at this early
stage.
We recognise that GPs are vital partners in the local
health economy and I am really looking forward to
working with you to develop even better services for
the people of East Lancashire.
During my first three months in post, I have been
struck by how calm and professional our hospitals
and services are. The standard of the estate and its
facilities has impressed me, as well as, of course, the
professionalism and compassion of the staff. I, for
one, would be happy to be a patient at one of our
hospitals.
arrangements.
Although these are very difficult times, the pressures
we have faced have released something of the
Dunkirk spirit in all of us. It was really inspiring to take
part in the management of the incidents.
As usual, I was very impressed by all our staff, what
they did, and more importantly, how they did it – with
calm professionalism. I wish I could say “that’s it, it’s
all over, pressure’s off”. It may be, for now, but I do
think we can expect more such high demand as we go
through winter.
My style is to always be open and approachable so
please feel free to contact me about any issues.
I intend to get out and about as much as possible to
keep in touch with the ‘sharp end’ of services, so I very
much hope we will meet in the near future.
In recent weeks there has been unprecedented
demand on our emergency services and a severe
shortage of beds, a situation which escalated
and led the Executive Team to treat as internal
incidents, managed by bronze and silver command
Kevin McGee
[email protected]
www.elht.nhs.uk
News Roundup
The Trust’s Maternity Service hosted a national conference at The Dunkenhalgh
Hotel to celebrate good practice in women’s experiences of maternity service.
Midwives and mothers presented and showcased maternity services in East
Lancashire, which was this year awarded ‘Maternity Service of the Year’ by the
Royal College of Midwives... read more
Patients and staff moved into the new £7.8 million Clitheroe Community Hospital
building on Chatburn Road. 20 inpatients transferred from the 141-year-old
hospital to the new Ribblesdale ward which is designed to be dementia-friendly
and offers 16 individual rooms and an additional 4x4 bed bay which can be
converted into single bedrooms if needed... read more
The Trust’s Endoscopy Unit gained national accreditation from the Joint Advisory
Group (JAG) on Gastro-intestinal Endoscopy. This accreditation is a measure
of quality which sees JAG accredited units operating to the highest standards.
Units have to be assessed externally every five years and submit self-assessments
annually... read more
A new prostate scanner which can diagnose cancers within minutes was officially
unveiled at Burnley General Hospital. The scanner, which is the showpiece in
the Trust’s newly opened Urology Investigation Unit at Burnley, will help detect
kidney, prostate and testicular cancers and will help waiting times for diagnosis...
read more
The Trauma and Orthopaedics service at East Lancashire Hospitals NHS Trust have
been awarded a number of NHS accolades for their work and patient outcomes.
This is the third major achievement for the service this year... read more
Wendy Harrison a Trainee Advanced Practitioner in the Emergency Department at
the Royal Blackburn, was awarded Pioneering Community Nurse of the Year in the
Welch Allyn Pioneers of Care Awards 2014. Wendy received a £500 bursary as part
of her award... read more
A £1 million investment to improve cancer care in the area has begun. The
Macmillan Cancer Improvement Partnership in East Lancashire and Blackburn with
Darwen is a pioneering three-year programme to provide better care and support
for cancer patients from the moment of diagnosis to beyond treatment... read
more
Since the introduction of degree-level nurse training, up to a quarter of student
nurses move elsewhere during the three-year course. The Trust’s Practice
Education Facilitator Team has worked hard to reverse this trend and we are
proud to announce that every one of the current first year student nurses has
chosen to continue their work and studies with ELHT... read more
The Trust was awarded excellent marks for standards of cleanliness, food, and
privacy and dignity in the 2014 Patient-led Assessment of the Care Environment
(PLACE) report. in September.. read more
www.elht.nhs.uk
THINK!
Help Us Help Patients
You will probably be aware that our hospitals, like many others, are facing
unprecedented demand in our emergency department which is placing significant
pressure on the whole Trust resulting in a shortage of beds.
We are asking members of the public to think hard about attending A&E, and to
only do so in a genuine emergency. Our partners in the health economy are also
supporting us through the THINK! campaign.
We know that GPs are also under significant pressure. If you are considering referral
for a medical urgent assessment of admission, you will be aware that alternatives are
available via the recently developed service ‘Navigation Hub’, the number you need is
0300 2471040.
In addition if you would like to speak to a consultant physician to discuss the need for
emergency admission, or have advice for treatment or urgent review in ambulatory
care or specialist clinics please ask for this when you ring Medical Assessment Unit
(MAU).
Consultants are available on site for this immediate advice from 8 am to 9.30pm, 7
days a week, and are on call overnight. Ambulatory care for urgent and emergency
assessments is now open 7 days a week over extended hours.
Thanks for your co-operation!
www.elht.nhs.uk
Winter Pressures
Following an unprecedented surge in the number of
people attending the A&E and Urgent Care Centres
at the Royal Blackburn Hospital and Burnley General
Hospital, the Trust is urging everyone to think if a visit
to hospital is really necessary.
Dr Ian Stanley, Acting Medical Director, said: “At
this time of year, we are especially busy which puts
additional pressure on our services and staff. We
ask people remember that our A&E and urgent care
centres are for injuries and illnesses that cannot wait
for a GP appointment.
In 2013, a combination of factors meant the Trust did
not always meet the four-hour national target for A&E
waiting times. However, we are now seeing systematic
improvements, thanks to close monitoring and several
initiatives, including:
•redesign of the Emergency Department to
provide a better environment for patients and
staff
•recruiting more medical and nursing staff
The ambulatory care unit which now sees patients
seven days a week has reduced admissions by
approximately 20-a-day.
On 7 October, the Trust Emergency Services including
Blackburn Emergency Department, Urgent Care
Centres at Burnley and Blackburn and the Minor
Injuries Unit at Accrington treated a total of 435
patients – 100% of them admitted, transferred or
discharged within the 4-hour national standard.
18-week Referral to Treatment
Overall, the Trust is meeting the 18 weeks Referral to
Treatment target though this varies from department
to department. Demand in particular clinical
specialties, staffing and staff workload can all impact
on this target.
To ensure delays are minimised, we are improving the
way we communicate with patients from the moment
they are referred, to make sure that they know about
their rights to treatment and their responsibility to
take an active part in their care.
•improved triage, with both consultant and GP
input
•ensuring diagnostics and a medical review are
carried out as early as possible
•opening a medical ambulatory care unit, led
by a consultant, for patients who do not need
admitting.
Vascular Centre of Excellence Update
In July 2013, the Trust was designated a centre of excellence for vascular services, along with Lancashire
Teaching Hospitals NHS Foundation Trust and North Cumbria NHS Foundation Trust.
Concentrating vascular services in specialist centres produces better outcomes for patients, in line with
recommendations from the Vascular Surgery Society of Britain and Ireland.
Simon Hardy Consultant Vascular Surgeon and Vascular Clinical Network Lead, said: “Plans continue and
there have been on-going discussions with specialist commissioners regarding working models to meet the
specification of a centre without a partner.
“The Trust Board has now approved the recruitment of additional members of staff including a consultant and
ward manager and has committed to a considerable investment in facilities to ensure the capacity required is in
place. Two operating theatres are shortly due to open plus a 20-bedded vascular ward which will enable us to
grow the service and keep activity going to meet the specification requirements.”
The project is being overseen by a Vascular Board and the specialist service aims to be up and running by April
2015.
www.elht.nhs.uk
Complaints Fall
Some important changes to the Trust’s complaints
process over the past year have resulted in 20 per cent
fewer formal complaints and faster resolution times.
The key reasons are that the Trust is dealing with
concerns and issues more quickly and effectively at the
point they arise are:
• the introduction of an on-call bleep system
so that senior staff can be contacted quickly to
meet with and listen to patients’ concerns
• a training programme which has increased
staff confidence in responding to patients’
concerns and reduced the chance of a concern
escalating to a formal complaint. If the
complainant is not on-site when the complaint
arises, contact is made usually by phone to
discuss the issues and where possible offer a
solution and apology.
Improvements in data capture and analysis have
also provided us with better and more accurate
information about the nature and source of
complaints. The majority of complaints are related to
aspects of clinical care and treatment, while the next
biggest category (although this is very small in actual
number) relates to the attitude of medical and nursing
staff.
Over the coming months, the Trust will assess if this
new data capturing mechanism accurately reflects the
reasons patients and families make formal complaints.
The Trust is also looking in detail at complaints by
ward to check if there are specific areas which need
addressing.
In response to comments that the complaints
procedure can be difficult to navigate, a new userfriendly complaints policy for patients/families should
be ready this autumn.
PR Works for COPD Patients
The Trust’s Pulmonary Rehabilitation Service for East
Lancashire has been redesigned to help GPs improve
the health of their COPD patients.
Pulmonary Rehabilitation (PR) has been shown
to significantly decrease mortality, morbidity and
hospital readmissions (Cochrane Review of Pulmonary
Rehabilitation, 2011), (Seymour et al, 2009) and the
East Lancs service complies with the recent Pulmonary
Rehabilitation Guidelines issued by the British Thoracic
Society in 2013.
The service provides a self-management and graded
exercise programme for COPD patients. Following
referral, an initial assessment at St Peters Centre,
Burnley will determine a patient’s suitability for
pulmonary rehab. If appropriate, patients commence a
twice weekly, six week programme provided at various
locations across East Lancashire, including Rossendale,
Nelson, Clitheroe, Burnley and Accrington.
During the six weeks, patients undertake a progressive
exercise programme and comprehensive education
sessions focusing on the self-management of their
condition. The Pulmonary Rehabilitation Team also
runs monthly breathe-easy support groups for COPD
patients.
GPs and Practice Nurses can contact the Pulmonary
Rehabilitation service on 01282 644131 or email [email protected] for more information.
www.elht.nhs.uk
UK first for hospital team
Drs Woodhead, Gavan and Hardy performed a keyhold procedure using an
advanced German-made stent to re-align a patient’s main artery.
A trio of surgeons working at Royal Blackburn Hospital became the first in the UK to perform a ‘keyhole’
procedure using an advanced German-made stent.
Dr Peter Woodhead, Dr Duncan Gavan and Mr Simon Hardy spent a nerve-racking three hours feeding the
device into a patient’s main artery, where a dangerous swelling had developed.
Stentgraft sections
Although the trio have performed hundreds of similar procedures using stents to realign the artery, this was the
first time they had used stentgraft sections to realign the iliac branch using X-ray technology.
Dr Woodhead, also an interventional radiologist, said the devices produce a much better outcome for the
patient, who would normally need full surgery, involving a much longer stay in hospital, and the costs
associated with intensive care during recovery.
First in the country
Although the technique has been used before by a handful of major hospitals, this was the first branched iliac
graft in the country to use a stent designed by the German firm, Jotec.
‘It was incredibly complex and we were all nervous beforehand.
‘We chose this device because it was a good fit for the patient and went through the procedure several times
with the company,’ said Dr Woodhead.
The Royal Blackburn was recently designated as a specialist centre for vascular surgery and interventions (see
update on Page 3).
www.elht.nhs.uk
Tongue-tie service reaches 300 milestone
The Trust’s Family Care and Surgery Divisions recently marked a milestone in the number of ‘tongue tie’
divisions performed.
Tongue tie can cause problems with breast feeding and sometimes bottle feeding as the baby has trouble
latching on. This, in turn, creates problems for both mother and baby who can be slow to gain weight and
suffer from colic and wind. The condition is often spotted by midwives or health visitors.
Frenotomy, the straightforward and painless procedure to fix the problem, is offered by the Trust’s MaxilloFacial Surgeons in an outpatient clinic.
The service, which started at the Trust three years ago, has now carried out over 300 procedures, also treating
patients from other areas where their local Trust does not offer this procedure or waiting times are too long.
Case Study
Baby Mia Logan is one patient to benefit from this
service. Mum Jaclyn Logan, from Blackburn, explains:
“After Mia was born she wouldn’t latch on and would
even struggle with drinking expressed milk from a
bottle - which I had done with my younger son who
I also struggled to breastfeed. She continued to lose
weight and was jaundiced so I was very lucky that my
midwife referred me to the infant feeding team at the
Trust.
‘They immediately diagnosed posterior tongue tie
and I went to see (Consultant Oral & Maxillofacial
Surgeon) Mr Cousin, who explained the procedure to
me and carried it out there and then. Mia didn’t cry
and immediately went back to sleep. Straight away
she started drinking far more milk with little trouble
and the infant feeding team helped me to get back
to breastfeeding which I didn’t think was going to be
possible.
Three months down the line, Mia has gained weight
and is thriving, easily drinking the amount of milk
needed.
Mum Jaclyn added: “I’d say that if any mum has
problems feeding, let your health visitor or midwife
know. I’d never heard of tongue tie and thinking
back, my son had probably suffered from a similar
thing though not as severe.’
Sue Henry, Infant Feeding Co-ordinator at East
Lancashire Hospitals NHS Trust, said: “Tongue tie is
surprisingly common though not very well known
and lots of babies with tongue ties will not have any
problems feeding and some will resolve over time by
themselves. However, a tongue tie division procedure
carried out when a baby is very young can be
worthwhile as they will not need an anaesthetic and it
can help the mother continue breastfeeding.”
www.elht.nhs.uk
Junior Doctors on Duty
In August, 69 FY1 junior doctors started their two-year
residencies with ELHT, joined by 117 speciality trainee
doctors as they begin ‘on the job’ training.
The Trust’s two-year integrated Foundation
Programme will now enable our FY1s to acquire
the core competencies required for hospital duty,
including an understanding of different settings in
which medicine is practised.
These include the core clinical skills required to care
for acutely ill patients as well as communication, team
working and IT skills.
The Foundation Programmes at East Lancashire have
been carefully constructed to provide a wide range of
educational opportunities both in the Trust and within
the community.
Linda Whitfield, Head of Clinical Education, said:
‘Our new doctors receive on-going support from
senior staff during their time here to help them in
their first jobs so we can pre-empt any problems early
on and better nurture their skills.
Shadowing
‘Junior doctors stay with the Trust for two years and
begin by shadowing the doctors and ward teams
they will be working with, as well as training for
prescribing, blood transfusion and resuscitation
competency.’
‘Patient safety and providing a high-quality service are
at the heart of East Lancashire Hospitals NHS Trust,”
says Medical Director, Dr Ian Stanley.
.
“This shadowing period could save lives, and equips
junior doctors with the local knowledge and skills
needed to provide safe, high quality patient care,
from their first day as a doctor.’
‘Life as a junior doctor can be a steep learning
curve but we offer the right support to ensure they
learn from their peers and that patient safety is not
compromised in any way.
Your NHS audiology service – local, quick and convenient
Hearing assessments by ELHT’s audiology department
are available at community locations across East
Lancashire and appointments are always available
within 16 days of referral but can often be offered
within three days. Referrals can be taken for patients
of any age.
The service operates from purpose-built audiology
suites, where highly-trained staff are able to offer the
latest digital hearing aid technology.
Assessments can be arranged via Choose and Book,
and fittings for hearing aids can be carried out at
the following locations, as well as at Royal Blackburn
Hospital.
Barbara Castle Way
Accrington Community Clinic
Darwen Health Centre
Clitheroe Hospital
Bacup Primary Health Care Centre
St Peter’s Centre, Burnley
Colne Health Centre
Pathology GP Survey
As a support service we aim to provide the highest level of quality we can. User satisfaction is of paramount
importance to us.
Please take a few minutes to complete this short pathology service survey and let us know what you think!
https://www.surveymonkey.com/s/3Z8JFZW
www.elht.nhs.uk
A day in the life of ...
Yasine is a newly-qualified doctor (Foundation Year 1) who joined the Trust in August. He is currently working
in the Obstetrics and Gynaecology Department at Burnley General Hospital and here gives a brief insight into
his first impressions of working at ELHT.
Having trained at Queen’s University Belfast, I am now practising medicine for the first time on the UK
mainland.
There were quite a lot of things to adapt to in my first weeks IN
East Lancashire. However, I was always able to find a solution to any
problems thanks to the consistently fast response from colleagues.
I firmly believe that the extra shadowing week provided at Blackburn
is what prepared me for the hectic first few weeks of FY1. Shadowing
a senior doctor allowed me to get used to the nitty-gritty of everyday
pressures as well as to the computer systems.
One of the most useful things was discussing controlled drugs with
senior colleagues helped in knowing how to document them correctly
(write the supply in letters and numbers) and sign them on the
discharging letters.
There was plenty of formal, structured learning as well: we were
introduced to the technicalities of ANTT (Aseptic Non-Touch Technique),
blood transfusions, the gas machine and CPR. The online learning
modules were invaluable for updating our knowledge, and the
protocols in helping us understand how the Trust works.
I would also like to commend the Thursday (and Friday for Obs and Gynae) lectures, especially the pharmacy
workshop which was very helpful on various drug interactions (Alendronic acid and Adcal D3). The 24 hour
library and internet access across the Trust make it very easy to access electronic journals.
Children’s Diabetes Service ‘Best in North West’
As diabetes continues to be a major public health
concern, the families of East Lancashire will welcome
news that the Trust’s Children’s Diabetes Service has
been rated equal best in the northwest.
Changing the face of diabetes care for children and
young people with type 1 diabetes in East Lancashire,
East Lancashire Hospitals was one of just 13 children’s
diabetes services in England to score 100% for their
hospital service, in the inspection carried out by the
National Diabetes Peer Review Programme. The
children’s multidisciplinary team was also highly
commended, receiving the highest score in the
northwest.
Dr Chris Gardner, Consultant Paediatrician, said:
“The inspection looked at all aspects of our service.
The feedback we received was exceptional and all
members of the team were congratulated on the
standard of service delivered!
“Good diabetes care in childhood can greatly improve
health in adulthood, and our team remains committed
to delivering the very best paediatric diabetes care.”
Rated No. 4 in the country for the performance of
its Multi-Disciplinary team, the Review highlighted
innovation by the hospital Children’s Diabetes Service
in reducing clinic waiting times and introducing
evening educational sessions to make it easier for
patients and families to attend together.
The Children’s Diabetes Service, including two
consultants, five paediatric specialist nurses, two
dieticians and a psychology practitioner, was specially
commended for its work with schools which includes
school clinics which
facilitate peer support
and educational sessions
for children with diabetes
when they start secondary
education.
Contact:
Paediatric Diabetes
www.elht.nhs.uk/departments-wards-and-services/
childrens_diabetes.htm
www.elht.nhs.uk
SPORT
Specialist Paediatric Physiotherapy Outreach Respiratory Team
A new service has been commissioned within Paediatric Physiotherapy called SPORT
(Specialist Paediatric Physiotherapy Outreach Respiratory Team).
The 12-month pilot, launched in July, aims to reduce hospital admission and length of
stay, facilitate discharge and improve patient function and outcomes whilst reducing
disruption to daily life.
SPORT provides an acute and community service responding to emergency and routine needs.
The service is for Paediatric patients with existing respiratory conditions including Asthma, Cystic Fibrosis and
Bronchiectasis, as well as Complex Needs patients with respiratory
issues.
SPORT accepts referrals primarily from Consultants, Respiratory
nurses and Physiotherapists and we engage with community
nurses, GPs and education.
We are based in the Physiotherapy Department, Level 1, Royal
Blackburn Hospital telephone 01254 732353 or email Natasha.
[email protected] or [email protected]
Case 1
Admission of teenager with CF for 2 weeks routine IV antibiotics. Discharged on day 7 with SPORT
follow-up saving 7 days inpatient stay. History of minimal visiting from family or friends during
inpatient episodes.
Significant improvement in quality of life during IV antibiotics and increasing acute bed availability.
Patient feedback – “I was sent home early because of SPORT, this was good because I was back in
my own bed and I got to see my friends and family. If the service wasn’t available I would not have
been able to go home”.
Tissue Viability Service
From 13 November, the new address and contact details for the Community Tissue Viability
Service are Room AD1.14, Level 1, Area 7, Burnley General Hospital, Casterton Avenue, Burnley
BB10 2PQ
Telephone
• Hospital Referrals
• Admin
• Nurses • Fax 01254 732349
01282 803108Ext 13108
01282 803111Ext 13111
01282 805175Internal 15175
www.elht.nhs.uk
Global Leaders
Trust staff are currently contributing to international research on the most effective treatment for cardiac
patients.
The Global Leaders study, aims to discover whether a new medication strategy can minimise complications in
patients receiving coronary artery stents and prevent blood clots forming within the stents. In total, 16,000
patients will take part in the study over the next two years at centres in Europe, Asia, South America and
Australasia.
The Royal Blackburn Hospital was the first in the UK to enter patients into the study and has been the first to
achieve an important study milestone as consultant cardiologist Dr Balachandran recently treated the 200th
East Lancashire patient to enter the study.
The team’s achievement was recognised by Professor Patrick Serruys, Chief Investigator for the study worldwide,
who congratulated Lead Researcher Dr Scot Garg and the research and cardiology team: “Our sincere
appreciation goes out to both you and your team for all efforts made to reach this huge accomplishment.”
Consultant Cardiologist Dr Scot Garg commented, “Clinical research is vital for improving health outcomes and
patient care. As a result of our patients’ kind participation and the work of the whole cardiology and research
team, we lead the UK recruitment centre over the last 12 months. This is just the beginning of our research
endeavours, and I am confident our patients will continue to participate in future studies, which we are already
setting up.”
The clinical research team is working with cardiologists, the clinical trials pharmacy team and staff on CCU,
ward B18 and in the cardiac catheter laboratories. And, as always, the support of the cardiology secretaries and
medical records staff has proved invaluable.
Karen Vaughan, Lead Research Nurse for the study at East Lancashire Hospitals, is thrilled with the team’s succes
“I am delighted with the amount of patients who have
been able to take part in this important study. We work
closely with the patients, through on-going follow up, to
ensure best patient care and to maintain their safety. Our
success would not have been possible without the support
of all members of staff involved in the study throughout
the hospital.”
The Global Leaders study is expected to continue through
to the end of June 2015. If you would like any information
about the study, please contact Karen Vaughan on 01254
732649 or email [email protected]
Dr Scot Garg, Debbie Wilcox, 200th study patient
John McCloskey, Karen Vaughan
www.elht.nhs.uk
Trust Recruits 3 Extra Oncologists
Cancer patients in East Lancashire have received a boost following the news that East Lancashire Hospitals
NHS Trust (ELHT) has successfully recruited three consultant oncologists to join the team of existing consultant
oncologists who visit from the Lancashire Teaching Hospitals (Royal Preston Hospital)
Joining East Lancashire NHS Trust immediately are cancer consultants Dr Doina Badea and Dr Ana Ferreira who
have clinics at both the Royal Blackburn Hospital and Burnley General Hospital.
A third new cancer consultant – Dr Raoul Peck – will start work with East Lancashire Hospitals NHS Trust in early
2015.
“We are extremely pleased to welcome Drs. Badea, Ferreira and Peck to East Lancashire Hospitals NHS Trust,”
said ELHT Cancer Services Manager, Juliette Mottram.
East Lancs Hospitals’ Cancer Services provide high quality surgical and non-surgical (for example, chemotherapy)
cancer services across all the different tumour groups for all major types of cancer.
These three new appointments add to a workforce including specialist cancer doctors and nurses who are
supported by multidisciplinary team coordinators and medical secretaries supported by a lead cancer consultant,
lead cancer nurse and lead cancer manager.
Consultant Medical Oncologist Dr Ana Ferreira comes to East Lancashire after gaining 14 years’ experience
in Portugal. She has a special interest in General Medical Oncology, Acute Oncology, Upper GI Cancers, HPB
Cancers (Liver, Biliary tract and Pancreas), CUP (Carcinoma of Unknown Primary) and Neuroendocrine tumours.
Dr Ferreira’s weekly clinics and held at Royal Blackburn Hospital on Monday and Tuesday afternoons, and
Burnley General Hospital on Thursdays.
Consultant Medical Oncologist Dr Doina Badea has 19 years’ experience as a qualified doctor and has a special
interest in breast cancer, gynaecology cancer and acute oncology.
Dr Badea’s weekly clinics are held at Burnley General Hospital on Tuesday and Thursday, and at Royal Blackburn
Hospital every Friday.
Ana Ferreira
(Joined in October 2014)
Doina Badea
(Joined in October 2014)
www.elht.nhs.uk
Enhanced Recovery, Reduced Mortality
Enhanced Recovery is a modern, evidence-based approach that reduces complications following major surgery
thereby allowing faster and smoother recovery, with benefits to the patient and the hospital. We look at many
aspects of the elective surgical pathway and with national guidance, and local innovation, we aim to improve
and standardise our care continuously.
Enhanced Recovery commenced at East Lancashire Hospitals in 2009 for major colorectal surgery. In 2011 it
spread to major Gynaecology, Hepatobilary, Urology and Orthopaedics (primary hip and knee replacements).
This had led to a steady reduction in length of stay and mortality in all our major elective surgeries
(approximately 2000 patients a year).
A multidisciplinary team approach is essential for success with, and sustainability of, these programmes. Over
the past year things have really gathered momentum, and the monthly steering group is well attended by
consultants, nurse representative for each area, nurse specialist, managers, data analysts, physiotherapists,
dieticians, pharmacists and the Acute Pain Team. So a huge thanks to all of you for your ongoing support.
In addition to improving patient outcomes, simultaneously improving the patient experience is at the forefront
of our objectives.
Patient feedback is very valuable to us. Here are a few examples of typical feedback on the programme:
A 64-year-old gentleman who had a total knee replacement said: “This admission has been brilliant. I can’t
believe I am going home on day 2. The staff were amazing. If I had to give them a score I would give them
11/10!”
Another 88-year-old patient who had laparoscopic bowel resection said on day 4 post-op: “I think Enhanced
Recovery is really good. They said I would have to go for some rehab but I already feel well enough to go
home”.
The new Enhanced Recovery protocols, pathways, guidelines and patient information is set to be launched in
January, striving to achieve standardisation in care. In 2015 we also aim to spread Enhanced Recovery to nonelective surgical patients i.e. fracture neck of femur, vascular amputations and emergency laparotomy’s.
We are currently trialling Enhanced Recovery in Medicine on C7, as these patients have also been shown
to benefit from elements of the Enhanced Recovery Pathway. The Family Division are soon to launch the
programme for elective caesarean sections.
Of course the philosophy of Enhanced Recovery, early feeding and early mobilisation, should be applied to all
our in-patients, regardless of a formal pathway.
Dr Anton Krige (middle, back row) with members of
the Enhanced Recovery Steering Group
www.elht.nhs.uk