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Enhanced recovery programme

By Sandra Dixon, Macmillan Thoracic Surgical Nurse Specialist, St James University Hospital

Category: Treatment

The problem identified

Enhanced recovery after surgery (ERAS) is an approach to the care of patients undergoing surgery involving a number of evidence-based interventions which collectively improve patient outcomes. It has been applied to colorectal, gynaecology, urology and musculoskeletal surgical specialities. It is now being piloted within thoracic surgery at LTHT to enable patients to recover from surgery and leave hospital sooner by minimising the stress responses on the body during surgery.

The intervention made to change the problem

All patients meeting the inclusion criteria are identified in clinic by the surgeon. Patients are given a diary in clinic and given an explanation of the programme. Patients then attend the patient education programme 1-2 weeks before surgery. On the day of admission the patients are given a preload drink at 6pm and again at 10pm. A further third preload drink is given on the day of surgery up to 2 hours before the procedure. Ward staff give patients the incentive spirometry on admission, with explanation of how to use it as part of the breathing exercises in the diary. 30-60 minutes pre-operatively a Bair Paws warming gown is put on the patient and remains in situ throughout surgery. Ward staff encourage the patients to complete the diary which is handed in to the ward on discharge and used for audit purposes.

How it changed my practice

This intervention will enhance patients experience both pre and post operatively and should ensure a better recovery.

Resource / Cost implications

The cost implication for each patient is approx £22.50, this includes the warming gown, incentive spirometry and the preload drinks.


Neal,K. Dejong, CHC, Fearon, KCH. Ljungqvist, O. Lobo, DN.Varadhan, KK (2010)The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery:A meta-analysis of randomized controlled trials. Clinical Nutrition.


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