Ethos of Enhanced Recovery After Surgery Implementation of ERAS The role of Physiotherapy in the Nottingham Upper GI Enhanced Recovery After Surgery Project Ethos of Enhanced Recovery After Surgery Thorough pre-op preparation of patient Use of minimally invasive techniques Milestones agreed by patients and clinicians MDT approach Access to treatment – 365 days year Rapid mobilisation post-op The Upper GI ERAS project was developed to focus on reducing the length of stay for patients undergoing oesophagectomy or gastrectomy at the Nottingham City Campus. The Physio Role - Evidence shows that early mobilisation post oesophagectomy and gastrectomy improves outcomes and reduces associated complications such as DVT and chest infection. While mobilisation has always been a priority for post op physio, we found we could standardise and improve this further during the ERAS project. This was achieved by developing milestones that are met by the patient daily which are progressively more demanding. The patient is made aware of these milestones pre-operatively and encouraged to aim towards them daily post op. At pre-op assessment, patients are encouraged to stop smoking if appropriate and increase their cardiovascular activity. The post op milestones include breathing and chest clearance exercises as well as mobility goals. PRACTICE pre-ERAS Less structured pre-op assessment Conservative mobilisation in early post-op period Patients less independent with treatment Ready for home day 12-14 Implementation of ERAS Milestones agreed preoperatively with patient Patient encouraged to exercise at home pre-op as chemo allows. Smoking cessation encouraged by MDT More aggressive mobilisation post op Use of incentive spirometry to guide patients chest exercises MDT reinforce milestones and aim for joint goals Use of Band 3 Physio assistant to progress mobilisation More frequent physio sessions Use of minimally invasive techniques and alternative analgesia to reduce hypotension and allow mobilisation OUTCOMES Patients are better prepared for post-op journey Rapid return to mobilisation Less respiratory complications Independence gained quicker Patient takes better ownership of their recovery Ready for home day 8 Audit data shows… Patients report that they find the milestones provide a clear pathway which they can work to. They appreciate receiving this information pre-operatively so that they can prepare themselves for the challenge. We found patients can meet their milestones regardless of age and co-morbidity in the majority of cases and some catch up even if they have had a complication post op. Patients return to the ward on day one in the majority of cases and gain independence quickly. Length of stay has reduced from 12-14 days to 8-11 days in the majority of cases. CONTACTS Cath McLoughlin Clinical Lead Physio catherine.mcloughlin@nuh.nhs.uk Laura Maddison Senior Physio Laura.maddison@nuh. nhs.uk Reference list available on request The future… Work on patients pre-op physical activity level to enhance post-op mobility Even earlier return to mobility Post discharge rehabilitation clinic which would include exercise sessions combined with an advice /support component. Provision of a 7 day enhanced recovery physio service.