Dr Martin Kuper Medical Director Homerton University Hospital speaks about new areas for Enhanced Recovery
Dr Martin Kuper, Medical Director at Homerton University Hospital, delivered a talk on New Areas for Enhanced Recovery.
He began by asking the audience which of them were from a medical, nursing pr physiotherapy background and which of them worked in an organisation that had an enhanced recovery unit already.
Dr Kuper was pleased to see a significant number of the audience did.
He talked about national progress around Enhanced Recovery since the launch of the national programme in April 2009.
Dr Kuper said there had been a 'partial realisation' of the goals and aspirations of that programme.
“But we're still not in the optimal efficient position where people are in hospital because they need to be,” he said.
He said one possible implication from the work that had been done since the launch of that programme was the idea that it might be less about what the actual care pathway said, but about sticking to it.
“It's more important that you can have everyone stand in a line and apply a plan consistently,” he said.
Dr Kuper talked about the National Inpatient Survey and how data from it it compared to patient experience data from those who were on the national enhanced recovery pathway and noted the significant improvements in experience reported by patients on Enhanced Recovery pathways.
“In terms of integrated care we have to try to coordinate heath and social care,” he said. “One of the first things we said when we launched was that all care should be ambulatory or enhanced recovery. “What we tried to do at the Whittington was to apply that to medicine as well so that where possible you would not need to be admitted.”
“What you're trying to do is turn a hospital inside out and only admit people when they need to be admitted, so you don't admit someone who comes in with a weight problem to diagnose whether or not they have cancer.”
Dr Kuper said one of the main problems with that model and around ambulatory care was in getting it funded and talked about the need to refine the tariff so admitting less people to hospital didn't lead to trusts not being paid for the care they were effectively still delivering.
“Some people will always need to be treated in hospital however,” he said.
He talked about the inefficiencies of the system where patients were admitted and what work had been done to improve that.
“The advantage of the ambulatory care at the Whittington is that the social workers come in every day, so that care is integrated,” he said.
Dr Kuper described the training programme for nurses implemented at the Whittington to help patients know what they needed to know to be safely and efficiently discharged from hospital.
He said the trust had made some good progress, with results around enhanced recovery for hip fracture showing marked improvement as well as emergency medicine average length of stay.
Future events of interest:
British Association of Day Surgery Conference: Quality in Day Surgery
National PROMs Summit 2014
Measuring and Monitoring Quality
Tuesday 20 January
ICO Conference Centre, London
Download: Dr Martin Kuper full presentation2 October 2014