Blog: Enhanced Recovery in the United States - Wendy Lewis

Earlier this year I was invited to cross the Atlantic for an exciting trip to Philadelphia, USA to take part in the first annual Transatlantic Enhanced Recovery Leadership Forum.

Wendy Lewis

Alongside a team of 5 other UK healthcare professionals, including surgeons and anesthetists, we were there singing the praises of Enhanced Recovery work within the UK; with my role being to represent this from a nursing and improvement perspective.

For those who aren’t familiar with Enhanced Recovery (ER), it’s an evidence and person-centred approach to care that started in elective colorectal surgery, but has since been widely adopted for many surgical specialties, including urgent or unplanned procedures.

The four main principles of ER ensure that patients:

• Are partners in their own care 
• Are in the best possible condition before surgery 
• Have the best management during and after their operation 
• Experience the best care to enable them to return to their normal level of activity as soon as possible 

Since the national programme ended in 2012, the NHS has gone from strength to strength with ER; seeing improved clinical outcomes, experience of care and productivity for patients, their family and staff. Internationally recognised, we’re now at a stage where countries from across the globe are looking to the UK to learn how they can begin their own journeys in implementing ER.

Recognising the potential for the UK to support ER in other health care markets, the trip was also supported by UK Trade & Investment, as well as Evidenced Based Perioperative Medicine (EPBOM).

Over the two days, we met with a number of senior leaders and clinicians from across the US, who were keen to hear our views on how ER could be designed, delivered and led within their healthcare system for maximum benefit to patients. Each member of the UK team also had the chance to present to the forum, and discuss their particular area of expertise.

It was really interesting to explore how the US health system might adopt our own work on ER, and reengineer it to meet their very different structures. Throughout the discussions we had a number of themes being considered:

• How do we create the case for implementing ER in the US? 
• What are the essential clinical components of ER that create maximum benefit to the patient, staff and productivity? 
• What data is important to capture in order to support sustainable improvement? 
• How do we create person-centred, value-added care within care pathways under difficult economic conditions? 

One of the highlights of the visit was a fascinating lecture from Professor Mike Grocott, of the Xtreme Everest research group. Describing their research on the effects of hypoxia (low oxygen levels in the blood) at high altitudes, this work has since been used to improve care in intensive care facilities, and in particular around diseases of the heart and lungs and severe infections. It really was amazing to hear how lessons learnt from the summit of Mount Everest have made their way to the bedsides of intensive care units.

Interest for ER in the US is now growing rapidly. With a strong body of clinical leaders now networking and beginning to work together more and more, it’s really inspiring to see this work progressing. I’ve also had the pleasure to help support this by co-writing an ER implementation guide for the American Society for Enhanced Recovery (ASER).

Whilst they’re keen to learn from the UK’s success, it’s also interesting to see that they face many of the same challenges in implementing ER as we did in England. Difficulties in creating clinical change and stakeholder engagement are nothing new, so looks like the reaction to change are the same on both sides of the pond!

Having spent a number of years working on ER within hospitals, the Department of of Health, and NHS Improving Quality, it was amazing to take part in this trip and learn about ER from a whole new perspective.

It gives me huge pride what clinical teams in the UK are now achieving for patients, and I’m sure my colleagues in the US will see those achievements too!

Wendy Lewis is AQuA’s Portfolio Lead for Experience & Engagement and Whole System Flow. You can contact her on wendy.lewis@srft.nhs.uk or follow her on Twitter @ERPwend.