UCLH Enhanced Recovery App (ER-App): improving peri-operative quality for elective surgery using data on pathway compliance and surgical outcomes University College London Hospitals NHS Foundation Trust

Enhanced Recovery (ER) is a set of best practice principles for recovery after surgery, focused on quick resumption of drinking, eating and mobility. Successful ER programmes can reduce post-operative complications and reduce hospital stays by <3.5 days. This project tested how giving the Oesophago-Gastric (OG) surgery multi-disciplinary team (MDT) better data on peri-operative quality metrics would influence the running of the unit and patient outcomes. It was based on a software application that automated the analyses of peri-operative data points, the ER-App.

The project dataset comprised peri-operative pathway adherence, patient outcomes and efficiency metrics. Following a positive response, the project began feeding back data to the MDT from March 2017.The team also worked through the data with individual specialties, such as physiotherapy, to explore areas where the pathway could work better. This showed success in raising pathway adherence, eg improving from 67% to 77% in physiotherapy.

Splitting the data from before and after the first feedback session in March, the median length of stay fell from 13 to ten days. Further important patterns emerged as the dataset increased. For example, patients who fail to walk around on day one after surgery have a 300% increased chance of developing a serious complication (here defined as requiring re-operation or threatening life). While this reflects existing research data, it was striking for the MDT to see it confirmed in their unit.

Another result showed that patients who suffer a complication spent a median 21 days in hospital versus nine days for those who did not, closely aligning improved patient outcomes with reduced costs. It is now planned to pilot changes to the unit, eg pre-operative physiotherapy sessions for patients, using the ER-App to drive and measure ongoing improvement.

Contact information

For more information about this project, please contact Professor Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care, Honorary Consultant Anaesthesia and Critical Care, and Director, Centre for Anaesthesia, UCLH.