A GIRFT study has found that adoption of enhanced recovery pathways following elective surgery can help to reduce the length of hospital stay for patients and contribute to easing the current NHS pressures on elective surgery.
The DrEaMing (Drinking, Eating, Mobilising) initiative is one of the most widely adopted. Despite concerns that such pathways can lead to early emergency readmissions to hospital if patients are discharged too soon, the GIRFT study published in in the British Journal of Anaesthesia found that in colorectal surgery shorter hospital stay was not associated with increased risk of emergency readmission and that compliance with DrEaMing was effective in reducing length of stay.
A team of GIRFT researchers analysed data for 124,580 colonic and 87,036 rectal surgery patients in England over ten years for the study entitled Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England.
Over the ten-year study period, the proportion of patients with a stay in hospital longer than the median for colonic and rectal surgery declined from 53% to 42% and from 49% to 37% respectively whilst rates of emergency readmission within 30 days declined from 10% to 8% and from 12% to 9% for colonic surgery and rectal surgery, respectively. After adjusting for demographic factors, patients with longer stay were more likely to be readmitted to hospital as an emergency within 30 days than patients with a shorter stay. The authors also found that greater levels of compliance with DrEaMing by trusts was significantly associated with shorter hospital stay for both colon and rectal surgery but not with 30-day emergency readmission rates.
Enhanced recovery pathways and initiatives such as DrEaMing can help support the recovery of elective surgical services following the COVID-19 pandemic and ensure that care is provided as safely and efficiently as possible.
The study was carried out by:
- Mindy Dawes: GIRFT clinical fellow
- Zoe Packman: NHS England Deputy Director of Nursing Service Transformation & Resilience (retired)
- Ruth McDonald: University College London Hospitals NHS Foundation Trust
- Mark Cheetham: GIRFT clinical lead for general surgery
- Nannette Gallagher-Ball: GIRFT clinical fellow
- Eleanor Warwick: King’s College Hospital NHS Foundation Trust
- Maria Oyston: Office of the Chief Nurse, NHS England
- Emma McCone: GIRFT national lead for preoperative assessment
- Chris Snowden: GIRFT clinical lead for Anaesthesia and Perioperative Medicine
- Michael Swart: GIRFT clinical lead for Anaesthesia and Perioperative Medicine
- Professor Tim Briggs: GIRFT chair and NHS England’s National Director for Clinical Improvement and Elective Recovery
- William Gray: GIRFT academic content lead
