UK ERAS pathways are well established but length of stay (LOS) is still longer than for international exemplar sites. This survey asked staff what they felt were the issues that needed to be addressed in order to reduce LOS further.
Attendees at a multi-disciplinary meeting (Enhanced Recovery in Orthopaedic Surgery Conference, Glasgow, Scotland, 20/01/15) were surveyed.
58 respondents from 23 hospitals in England, Scotland and Ireland were made up of nurses (27), physiotherapists (18), anaesthetists (7), occupational therapists (3), surgeons (2) and a pharmacist. 54 respondents had two or more years experience working in ERAS.
The staff surveyed thought that the most important factors in order to achieve a short LOS within their own hospitals were:
When the respondents were asked which issues they felt they needed to improve within their own hospitals to shorten current LOS, 35 thought that better post-operative analgesia was required and 29 thought better pre-operative patient education and expectation management were required.
There were three other major themes:
One respondent commented Sometimes people can have severe pain but achieve goals and go home early.
Experienced ERAS staff cited pre-operative patient education and post-operative analgesia most frequently as key factors in achieving a short LOS, but as a group also identified these two steps as the ones most needing to be improved. Managing the side effects of anaesthesia, improving physiotherapy access, and greater social and community support post-discharge were also deemed important.