7/28/2019 Enhanced Recovery for Colorectal Cancer Surgery:
Improving Post-Discharge Support
1/1
nhanced Recovery for Colorectal Cancer
urgery: Improving Post-Discharge Support
dical Education Unit & Dept of Surgery, Queens Medical
Centre, Nottingham University Hospital, UK
A. Ole, J.E.F. Fitzgerald, J. Stewart, A.G. Acheson
roduction
hanced Recovery protocols are increasingly facilitating early
hospital
harge.
hanced Recovery takes several measures (see Figure 1) to allow
for prompt
harge and recovery following a major operation.
ecent meta-analysis of clinical trials indicates higher
readmission rates post-
han traditional care.
s study investigated community practitioners experiences of
enhancedvery following colorectal cancer surgery.
thods
ients were identified from a prospectively maintained cancer
registry at a
onal teaching hospital from January 2007 - September 2008.
neral Practitioners of surviving patients were contacted
retrospectively with an
m questionnaire (Figure 2) assessing their knowledge and
experience of
ng for enhanced recovery patients.
e questionnaire was anonymous and a free text area was provided
for
titioners to add their own comments regarding their experiences
at managing
e patients.
Take home messages
There is little knowledge of enhanced recovery after discharge
amongst
community practitioners.
Surgical teams should educate and improve communication with
community
practitioners.
Surgical teams should provide better post-discharge support to
minimize
readmissions.
sented at the ESCP - Prague, September 2009
ntact Mr Edward Fitzgerald: [email protected]
Conclusions
The overwhelming majority of community practitioners have not
heard of
ERAS
The nursing resources in the community are inadequate to cater
for
increasing needs of ERAS patients
There is insufficient communication between secondary and
primary care
regarding hospitalised patients
Insufficient communication hinders patients care in the
community
ReferencesKehlet H, Wimore DW Fast-track surgery British Journal
of Surgery 2005;92 3-4
Fearon KCH et al Enhanced recovery after surgery: A consensus
review of clinical care forpatients undergoing colonic resection;
Clinical Nutrition 2005
Kehlet H, Fast-track colorectal surgery The Lancet
2008;371:791-3
Fearon KCH et al Enhanced recovery after surgery: A consensus
review of clinical care forpatients undergoing colonic resection;
Clinical Nutrition 2005
Walter JC et al. Enhanced recovery in colorectal resections: a
systematic review and meta-analysis Colorectal Disease 2009;11
344-353
sults
dian age was 72, ranging from 28 to 96
Major problems and concerns that GPs encounter in community
Difficulties managing wound and other post-op infections
13.0%
Lack of or incomplete communication from hospital on discharge
36.2%
Inadequate pain medication with the patient on discharge
8.7%
Inadequate resources regarding District Nurses for patient
review 15.9%
Table 1. Major problems and concerns encountered by GPS in the
community
e 1. Components of ERAS protocol
Median ASA score was 2, ranging from 1 to 4
187 patients underwent enhanced recovery CRC surgery during this
study
period. 128 unique GPs were contacted with response rate = 69
(53.9%).
91.3% were not aware of the enhanced recovery protocols.
Major post-operative problems encountered in the community:
infection
(13.0%), inadequate communication from hospital (36.2%),
inadequate
nursing resources (15.9%).
27.5% of respondents felt they had inadequate facilities to deal
with
enhanced recovery patients.
44.9% of the practitioners stated requirement for increased
numbers of
community nurses.
40.6% of respondents stated communication issues as main factor
hinderin
patient care.
Key themes from questionnaire responses: need for detailed /
prompt
discharge plan and contacts for surgical team
Figure 2
Questionnaire
sent to GPs
