An updated Commissioning for Quality and Innovation (CQUIN) indicator, helping to ensure more patients are supported to drink, eat and mobilise within 24 hours of major surgery, has been published for 2023/24.
Drinking, eating and mobilising (known as DrEaMing) is a simplified programme of care intended to revitalise efforts to improve patients’ recovery after surgery. It is a key element of enhanced recovery programmes, helping to prevent post-operative blood clots and respiratory complications. Data from the national Perioperative Quality Improvement Programme (PQIP) found DrEaMing to be associated with a 37.5% reduction in postoperative length of stay (LoS). As the NHS works to recover elective services post-pandemic, reducing LoS can increase capacity and help to reduce the backlog of patients waiting for surgery.
NHS England’s CQUIN framework is designed to encourage providers to improve the quality of services and adopt new, improved patterns of care. The DrEaMing CQUIN was among the indicators featured in the 2022/23 scheme; the updated version for 2023/24 includes a wider range of procedures and a revised threshold so that it continues to be challenging, but achievable. Providers are now encouraged to ensure that 80% of inpatients undergoing major cranial neurosurgery, spinal, endocrine, breast, ENT, oral and maxillofacial, general, cardiothoracic, vascular, urological, orthopaedic or gynaecological surgery are supported to DrEaM within 24 hours of surgery.
The criteria requires patients undergoing major surgery to be provided with fluids and suitable food, and to be supported to mobilise from their bed to a chair, but also includes those discharged without an overnight stay in hospital.
Guidance for the 2023/24 scheme can be found on the NHS England website, as well as indicator specifications.
Professor Ramani Moonesinghe, NHS England’s national clinical director for critical and peri-operative care, said: “I’m really delighted that DrEaMing has been supported again by CQUIN for 2023/24. Delivering this simple care bundle as standard is an important step forwards, both to ensure patients undergoing major surgery get the best care and in helping the NHS to recover elective services.”
The 2022/23 CQUIN and the updated 2023/24 version have been supported by the Getting It Right First Time (GIRFT) programme and a wide range of stakeholders, including the Royal College of Anaesthetists and the Centre for Perioperative Care. GIRFT’s 2021 national report for anaesthesia and perioperative medicine identified an urgent need to refocus attention on enhanced recovery pathways and ensure that they are adopted for the majority of surgical inpatient procedures. The report promoted the use of DrEaMing to help achieve its recommendation to develop or reinvigorate an enhanced recovery culture, driven by the entire multidisciplinary team involved in the perioperative pathway.
A webinar to support CQUIN implementation will be hosted by PQIP and the Royal College of Anaesthetists on 7th March: register below.
