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Enhanced Recovery in Upper GI Surgery

The Enhanced Recovery Programme in Upper GI Surgery started in April 2012, concentrating on patients undergoing elective Oesophagectomy. This expanded to incorporate patients undergoing elective gastrectomy (extended total gastrectomy, total gastrectomy, subtotal gastrectomy, partial gastrectomy) in April 2013.

In September 2015, the Upper GI team incorporated learning from their visit to Seattle, USA to further enhance the Oesophagectomy pathway and related care delivery. This learning was then translated into an updated Oesophagectomy pathway which was launched in June 2016.

The creation of patient information leaflets has enabled the pre-operative assessment staff to explain the principles of enhanced recovery to the patient, as well as the patient's role in their postoperative recovery, including what to expect after the operation.

Patients are encouraged to complete a diary in the days after surgery, so that they can monitor their progress and recovery in line with the enhanced recovery principles of early mobilisation and early nutrition.

Postoperative care pathway

The postoperative care pathway is used to standardise the nursing and medical documentation and to achieve a high quality of postoperative care. The postoperative pathway details all aspects of multi-professional care, and sets targets for the patient to achieve on each postoperative day up until discharge from hospital.

The goals and targets include:

  • the patient walking a little bit further on the ward every day
  • teaching the patient how to care for their feeding tube if appropriate
  • teaching the patient how to give themselves daily Dalteparin injections, so they are able to be as independent as possible, and have the confidence to care for themselves when they go home.

Discharge from hospital is based on certain criteria, of which both the patient and the multi-professional team are aware; once these criteria are met, the patient is deemed safe to be discharged from hospital.

We are currently reviewing our Gastrectomy Enhanced Recovery Programme so that it continues to meet the needs of our patients.

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