Interdisciplinary Prehabilitation Pilot for Elective Colorectal Surgeries at Our Lady of Lourdes Hospital
Our Lady of Lourdes Hospital in Drogheda initiated an interdisciplinary prehabilitation pilot program for patients undergoing elective colorectal surgeries. The program aims to reduce length of stay by addressing modifiable risk factors and optimizing patients' physiological reserve. By targeting postoperative complications and enhancing patient outcomes, the pilot seeks to achieve a significant reduction in average length of stay following specific surgical procedures. The pilot involves various healthcare professionals and sets clear goals to enhance patient care and recovery efficiency.
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Our Lady of Lourdes Hospital Our Lady of Lourdes Hospital Drogheda, Surgical Drogheda, Surgical Department Department An Interdisciplinary Prehabilitation Pilot for Patients Undergoing Elective Colorectal Surgeries Ms Eleanor Faul (Consultant General Surgeon) Jillian Smith (Senior Physiotherapist) Claire Treanor (Senior Occupational Therapist) Maria McCabe / Eileen Beagan (Dietician)
Background Modifable Risk Factors Impacting aLOS Age D/C Planning Marriage Post-op Delirium Cognitive Screening Post-op Complications Comorbidities Exercise & Diet Pre-op Function In 2020, elective colorectal cancer surgical procedures accounted for 461 bed days in Our Lady of Lourdes Hospital (OLOLH), averaging 461,000. Recommended average Length of Stay(aLOS) KPI for Anterior Resection is 8 days(NCP Surgery 2013). In OLOLH, median aLOS for Elective Anterior Resections between 2016-2020 was 10 days, 2 days over the KPI. Hartmanns Reversal aLOS is recommended as 8 days. In OLOLH the median aLOS between 2016-2020 was 9 days. Prehabilitation aims to reduce length of stay by identifying and managing any modifiable risk factors that may impact aLOS and optimise patients physiological reserve to reduce postoperative complications. aLOS for Elective Anterior Resections between 2016-20 vs National KPI 35 Frailty Respiratory Optimisation PHYSIOTHERAPY 30 Cognitive Monitoring Equipment Provision Discharge Discussion 25 20 15 Exercise Tolerance 10 OLOLH Prehab Pilot 5 0 2016 2017 2018 2019 2020 OCCUPATIONAL THERAPY Median Goal Aim: To reduce the aLOS for patients admitted for elective anterior resection surgery from 10 days to 8 days and elective Hartmann s reversal from 9 days to 8 days by January 2026 Psychological Support Nutrition DIETITIAN
Phase 2 Phase 3 Phase 1 All surgeries for Ms Faul Open to all surgeons Referrals for Ms Faul colorectal only Pilot Goals Phase 1 Outcomes Research EBP and review local HIPE Data Need for pilot identified Discussion with Surgical Lead and all stakeholders Adapt phase 2 of pilot in line with feedback received and phase 1 outcomes Primary Outcomes Primary Outcomes - Reduction in post-op mortality - 0 Postoperative Complications - Reduction in need for continuing care/interim bed/increased support - 0 Complex Discharge Referrals - Reduced post-op complication rates Act Plan Secondary Outcomes - 100% Reduction in aLOS to achieve KPI Secondary Outcomes Study Do - Reduction in Length of Stay (LOS) - 6 days saved on aLOS for patients admitted for anterior resection ( 50,000 per patient) Analysis of qualitative and quantitative data collected and review of outcomes - Reduced re-admission rates Development & commencement of pilot phase 1 - Financial savings
The programme helped me get ready for surgery and think about home after Education session to Consultants at Surgical Governance Meeting and rolling education with NCHD. Senior Surgical Physiotherapist in post and in 2021, Senior Occupational Therapist converted from rotational to Permanent Post and designated roles of each MDT identified. Referral Form allows easy delegation. Known patients then have reduced therapy requirements on admission reducing caseload of PT/OT/Dietitian. Sustainment I was able to chat to my family about the help I would need when I got home and make sure there would be someone there to help me Presentation during Grand Rounds in January 2022 Poster presentation at conferences Spread I ve really improved my fitness with this programme. It s helped me lose 1 stone before my surgery Overwhelmingly positive feedback from patients and carers. Patients report feeling physically and psychologically better prepared for surgery with knowledge of peri-operative and post-operative expectations. This pilot enhances evidence-based ERAS practice in OLOLH, improving the quality and safety of service provision. Value to Patients
