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Skip to 0 minutes and 7 seconds We had a national programme for enhanced recovery that ran in the UK– from about 2008, 2009, to 2012– where we tried to establish it as the new norm for all forms of elective major surgery. Was that successful? It was initially very successful. So it was a very dramatic move in the needle from those practises being much more commonly accepted. We saw an overall reduction in length of hospital stay for elective surgery. We saw no increase in readmission rates. We saw high levels of patient satisfaction. But I have to be honest, it looks as though in the recent years– 2012, in particular onwards, the last four years or so– that we’ve plateaued.

Skip to 0 minutes and 51 seconds If you look at the National Colorectal Audit, it looks as though we’ve stalled in that rate of progression. Is that because we’ve just hit the skids with the sorts of patients we’re dealing with? Or is it that you failed to empower me? So my if my elderly mom had gone in– Yep. How would I know what was meant to happen to my mum and make sure it happened? I still don’t know, overall. I think we do know we’re working in a system that feels under intense pressure at the moment, from resource availability, manpower, to a certain extent the morale of the individuals concerned.

Skip to 1 minute and 25 seconds But when we looked locally, here at UCH, we found that the compliance with the elements of the pathway had slipped considerably. So because we had no reliable feedback loops– no monitoring of compliance with pathways, no live dashboards that told us about our outcomes– that we were working in an information vacuum.

How to engage with protocols

In the above video, Professors Monty Mythen and Hugh Montgomery discuss the initial success of the enhanced recovery pathway. However, they also acknowledge a plateau in the success of ER and propose some reasons for this.

Having watched the video do you agree with their reasoning? What do you think are the main challenges for staff and patients engaging with enhanced recovery in your department?

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This video is from the free online course:

Perioperative Medicine in Action

UCL (University College London)