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Enhanced Recovery Programme

The K.J. Drabu Enhanced Recovery Programme aims to improve patient care and experience by focusing on effective analgesia, minimizing gastrointestinal problems, and reducing complications. The program emphasizes early discharge and encourages good mobility post-surgery. It begins with thorough pre-assessment involving GP, physiotherapist, and nursing staff, ensuring clear communication with the patient and their home support team. Key strategies include patient involvement, pre-operative preparation, and a positive approach from the outset, leading to safer, quicker rehabilitation, and enhanced overall satisfaction.

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Enhanced Recovery Programme

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  1. Enhanced Recovery Programme K J Drabu Consultant Orthopaedic Surgeon

  2. Aim Improve patient care and experience Good analgesia Minimal GI problems Minimal complications (Surgical & General) Early discharge Good mobility

  3. Where does it start and where does it go? • Patient • GP • Pre-assessment – Physio and nurse • Surgeon/Anaesthetist • Ward staff • Patient

  4. Philosophy • Positive approach from the start • Patient and home support team pre-prepared • Clear understanding of the whole process • Emphasis on early and safe mobility • Encourage the patient to “lead”

  5. Patient • Aware and requesting the procedure • Word of mouth and media • Defined admission date and defined discharge date • Home support in place when needed

  6. GP • Aware of the process • Pre-prepares patient for process – Co-morbidities, smoking, bowels etc • Pre-prepares home support • NOT RAPID DISCHARGE

  7. Pre-assessment – Physio and Nurse input • Positive approach • Point of contact for patient • Deal with any issues – Pain, smoking, bowels etc • Prepare for appropriate mobility • Pre-op exercise programme

  8. Anaesthetic • Single shot spinal • Propofol • Tranexamic acid and intra-operative re-transfusion • IV Abx • Ondansetron • IV Fluids to 1 Lit intra-op

  9. Operative Technique Standard procedure • A/lat approach, supine • Mini-incision • Preservation of Glut Medius Obese patients • Posterior approach TO DRAIN OR NOT TO DRAIN??

  10. Mini Incision • 2 cms greater than cup • 10 cms or less • Minimal disturbance to soft tissues • Berger – Chicago (Dual incision) • AMIS

  11. Mini- Incision THRs Advantages • Less soft tissue disruption • Quicker rehabilitation • Less blood loss Disadvantages • Less visualisation • Risk of complications

  12. Indications for Mini Incision THRs • Not overweight patient • Good bone • “Normal” arthritic hip joint • Not bilaterals? • 95%

  13. Antero-lateral approach • Preserve Glut Medius • Leg length • Cup orientation • Stability

  14. Post-operative (Ward) • Early mobility • Self management – exercise programme and mobility • Catheter – In/Out • Avoid bed pans THERE IS NO BETTER FEELING THAN FEELING NORMAL

  15. Ward (Physio & Nurse Lead) • Self mobility • Positive feedback • Act quickly where needed • Re-assure re point of contact • Inform Consultant of any problems after discharge • Contact telephone for follow up

  16. Enhanced Recovery Thanks to Jackie Stayton For leading this project THANK YOU

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