Enhanced Recovery After Surgery (ERAS) programme

Carrie Scuffell, Lead Nurse for enhanced recovery in transplantation, Freeman Hospital, Newcastle-upon-Tyne NHS, explains how a grant of £103,740 from Kidney Care UK has enabled Freeman Hospital to introduce an Enhanced Recovery After Surgery (ERAS) programme for kidney transplant patients.

"We aimed to create an Enhanced Recovery After Surgery (ERAS) programme for our kidney transplant patients"

“The funding was for one year and paid for an ERAS nurse and Physiotherapist. The programme is designed to help patients recover more quickly from their transplant operation and encourages them to play an active role in their care. We provide patients with education and set daily targets for the patients and the transplant team. Our kidney transplant recipients had a length of hospital stay after their transplant of twelve days compared to the national average of eight days.

"ERAS programmes have been widely used for other types of surgeries. They have been shown to increase patient involvement and autonomy, ultimately making better use of resources, reducing the length of stay, and reducing the risk of postoperative complications and side effects. Since Covid-19, reducing the time patients are in hospital, avoiding unnecessary potential exposure to Covid-19, and other viruses, has become even more important.”

“The communication was great. I was self-medicating with supervision, they checked my medications, observations, and urine output. I felt like part of the team.
ERAS patient

Evidence gathering

“We carried out a national survey, gathering information from all 23 UK transplant centres on perioperative practices (before and after the surgery) and feelings towards ERAS. The findings from this survey have been published in the medical journal the Annals of the Royal College of Surgeons of England.

“To help encourage a change in culture and practice the multidisciplinary team also helped to shape the development of this. We learned not to give up and when the Trust was unable to support the project financially, we reached out to charity. Thanks to Kidney Care UK we were able to make what had seemed impossible, possible. The success of the ERAS programme is evident from the feedback we received from the staff and patients.”

To make sure the programme was patient-centred, patient representatives from Tyneside Kidney Patients Association (TKPA) were consulted. This provided the backbone of the patient perspective, bringing useful feedback and ideas, and helping with the development of the patient journal.

It’s been fantastic to see how everyone has worked together to help the recovery process after transplant surgery be quicker and easier. Most importantly, it’s brilliant to see our patients understanding their recovery, feeling well and being discharged home so much earlier after their transplant surgery.
Dr Frankie Dowen, Consultant Nephrologist, Freeman Hospital

Stages of ERAS

There are three main stages to our ERAS programme:

Stage 1: Help patients better prepare for their transplant.

We do this by providing information, talking through the principles of enhanced recovery, what to expect whilst they are in hospital, and introducing them to the patient journal. The journal is designed to support patients during their hospital stay. It provides them with daily information and provides a section for them to record progress. We are developing a digital version of the journal in partnership with Patients Know Best (PKB) and we hope to add valuable resources that patients will be able to access.

Stage 2: A combination of elements of patient care, around the time of the transplant operation, that we use to structure their recovery.

This includes changes to pain relief and the way we manage fluids. Fewer tubes and lines, where possible, and a personalised physiotherapy-led mobility programme. Daily targets for both the patient and the transplant team provide a framework to help patients recover more quickly. We encourage patients to be involved in their recovery and use their journals to record their progress.

Stage 3: Help patients go home sooner if they are ready, and we continue to support them closely at home.

Early patient involvement and feedback were pivotal in ensuring the programme was patient focused. This was evident in our patient testimonials.

Ongoing staff education and feedback are vital to the continued success of the programme. Staff have provided useful ideas and feedback to help continue to improve our service to patients.

It amazed me how busy everyone was and still had time to educate me to help me stay in control. I will be eternally grateful for that. I would definitely recommend ERAS. Great team, great for the patient journey. Thank you.
ERAS patient

The future of ERAS

I was delighted to receive The Q Factor award on behalf of the ERAS team. Launched by the Trust Clinical Audit and Guidelines Group, the award highlights the excellent work that happens throughout the Trust to deliver Quality Improvement. It’s fantastic to see everyone’s hard work being recognised and appreciated. We hope that our programme will offer inspiration and ideas to others wanting to develop quality improvement projects, benefitting more patients in other departments in the future.

Enhanced Recovery After Surgery (ERAS) programme
Dylan Day, Aimen Amer and Carrie Scuffell from the ERAS team

“We are now working on how to help patients to stay well or even improve their fitness while they are on the transplant waiting list. We are creating an electronic version of the journal. Patients will be able to access this by the app or website Patients Know Best, which will provide access to blood results and useful patient information.

“Following the success of the programme, we are looking to develop ERAS programmes for patients needing liver and pancreas transplants.”

The ERAS process is by far the best advance in hospital care I have seen. It is patient focussed, and as a patient, it gave me back some control over my mind and my body.
ERAS patient