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Enhanced Recovery Programme Elective Colorectal Surgery Hywel Dda Health Board Glangwili Hospital

Enhanced Recovery Programme Elective Colorectal Surgery Hywel Dda Health Board Glangwili Hospital. ERAS at Glangwili:. Implemented 13th September 2010 All elective colorectal surgical procedures All 4 Consultant surgeons signed up

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Enhanced Recovery Programme Elective Colorectal Surgery Hywel Dda Health Board Glangwili Hospital

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  1. Enhanced Recovery ProgrammeElective Colorectal SurgeryHywel Dda Health BoardGlangwili Hospital

  2. ERAS at Glangwili: • Implemented 13th September 2010 • All elective colorectal surgical procedures • All 4 Consultant surgeons signed up • Full MDT involvement (physio, dietitian, colorectal CNS, anaesthetists, surgeons, pre-assessment, ward staff)

  3. Data from initial 79 patients: • Mortality n=3 (<4%) • Data of remaining 76 patients • Average age 69.1 years • Re-admission rate n=3 (<4%) • Open procedures n= 74 (97%) • Laparoscopic n=2 (3%)

  4. Total length of stay:3 day reduction in LOS through implementation of ERAS

  5. Post-op length of stay:

  6. Total LOS run chart:

  7. Reduction in LOS not achieved through change to DOSA as only 9% of patients admitted the day of surgery If DOSA admission was implemented total LOS would be reduced to 6.7 days

  8. Type of surgery:

  9. Bundle compliance: Immediate Care B2

  10. Individual elements affecting B2 bundle compliance:

  11. Bundle compliance: Intra-operative care B3

  12. Individual elements affecting B3 bundle compliance:

  13. DOSA: Identified as area for improvement at LS4

  14. Bundle compliance: Post-operative Care B4

  15. Individual elements affecting B4 bundle compliance • % of patients (median): - Timely IV fluid removal 66.7% - Timely catheter removal 63.3% - Sat out in chair 6-8 hours daily 86.1% - Achieved x4 walks daily 63.3% - Sat out in chair day of surgery 27.8%

  16. Bundle compliance: Discharge/Follow-up B5

  17. Areas identified for improvement: • Post-operative fluid management • Daily weighing of patients • Staff education due to recent ward changes • Increase bundle compliance

  18. Positives: • Improved team work • Continued enthusiasm • Sustained reduction in LOS • Agreement with surgeons re: bowel prep • Move towards DOSA • Adapted ERAS documentation to include POMS, daily weight and fluid management plan

  19. Thank you

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