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Nurses leading drive to cut hospital stays in half

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A scheme to improve post operative care that has been championed and developed by nurses is being accelerated across the country amid evidence it could save 200,000 bed days a year.

Nursing Times has learnt that, following successful pilots, dozens of trusts are planning to extend or adopt the enhanced recovery model, which aims to mobilise patients more quickly after surgery.

This can involve hospital nurses continuing to monitor patients long after they have been discharged, in some cases providing follow-up care that would traditionally have been provided by GPs.

It comes as the Department of Health has issued a guide providing details on the results achieved by test sites, which have managed to reduce mortality rates, waiting times and the length of patient stays.

Royal College of Nursing peri-operative nursing forum chair Ciarán Hurley said: “This is quite a sea change in approach. Many smaller trusts may have been cautious about seeing whether it works before making the investment.”

The DH guide claims that that bed day savings of between 140,000 to 200,000 could be made if the model is implemented nationally in colorectal, gynaecology, urology and musculoskeletal surgical specialties.

University College London Hospital Foundation Trust has adopted the approach for most colorectal and liver surgery patients and is expanding this to upper gastro intestinal procedures from May.

Patients attend a pre operative clinic, where they are given carbohydrate loading drinks in preparation for surgery, and told they will be up and about soon after their operation.

After discharge, they are able to phone or visit enhanced recovery nurse specialist Rachael Nakawungu, who deals with any problems and questions.

“Readmissions have gone down because patients have me to call for things they’re worried about and used to bring into hospital”

Rachael Nakawungu, enhanced recovery nurse specialist

Ms Nakawungu said: “Departmental readmissions have gone down because patients have me to call for things they’re worried about and used to bring into hospital or go to their GP with.”

Bed days for colorectal patients have also been halved from 12 to 14 days to 6 to 8 days, and the hospital is now considering applying the changes to orthopaedics, gynaecology and urology.

The model is being seen as one of the ways nurses can contribute to the quality, innovation, productivity and prevention agenda.

Timely, nurse-led discharge schemes have been identified as one of the eight high impact actions for nurses and midwives to improve care while reducing costs, set out by the NHS Institute last year.

The average NHS patient on a surgical ward costs up to £400 per day. This means a reduction in length of stay of between two and six days per patient could save NHS trusts between £15.5m and £46.5m a year, according to experts.

The Whittington Hospital Trust has estimated the scheme will save its colorectal department £250,000 a year.

Bed days have plummeted from an average of 20 days to six, and nurses hope to bring this down even further.

Enhanced recovery nurse Aundrea Mulreany, who has recently taken up her post, said preparing patients for discharge as soon as they emerge from surgery involved “a new way of thinking” for patients and staff.

Patients are mobilised six hours after theatre, have catheters, drips and drains removed and are given fluids as soon as possible.

The trust no longer refers to it as a “fast track” scheme because “that made it sound like we were pushing them out before they were ready,” said Ms Mulreany.

Mr Hurley said it was important any savings were reinvested, enabling high nurse-staff ratios in recovery units.

He said: “There’s always a slightly sinister discourse that it [enhanced recovery] is an attempt to cut budgets. There’s a saving, but that’s a good thing if it means investment in another area.”

He recommended trusts taking up the model ensure detailed handover notes are written for patients moving between units.

The changes also required doctors and laboratory workers to work flexibly rather than within traditional hours, he said.

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