In this section
What is an Enhanced Recovery Programme?
Enhanced recovery is a modern, evidence based approach that helps patients who are undergoing surgery to recover more quickly. Different members of the hospital and primary care team work together in order to ensure patients are:
- as healthy as possible before receiving treatment
- receive the best possible care during their operation
- receive the best possible care while recovering
How does it work?
We are committed to managing your care based on your individual needs during and after your operation. We aim to:
- Reduce pain with anaesthetic techniques and medication to suit you
- Use minimally invasive surgical techniques where possible
- Support and encourage early movement and activity
- Remove drips, drains and catheters as early as possible
- Reduce post operative nausea and vomiting by managing your fluid balance and with medication.
We recognise that leaving hospital after an operation can be daunting after having 24 hour support from qualified staff. We therefore offer a telephone follow up service where you can discuss any worries or concerns with a specialist nurse following your discharge from hospital.
We want you to play an active role in your recovery and we aim to do this by giving open and honest communication regarding your condition, treatment and hospital stay and by providing you with information on how you can best prepare.
Some of the things you can do in the run up to your operation include:
- Eating well – This will fuel your body in preparation for repair.
- Exercising – Keeping active will help to speed up your recovery.
- Giving up smoking – Going smokefree speeds up the healing process and reduces your risk of complications such as chest infections following surgery.
To find out more about the enhanced recovery programmes we provide for individual surgical specialties, please select from the
Colorectal
If you are coming into hospital for major bowel surgery the colorectal enhanced recovery programme aims to get you back to full health as soon as possible following your operation. Mr Rajeev Kushwaha is the Consultant Surgeon who led this initiative in colorectal surgery and is the Trust Lead for Enhanced Recovery.
Before your procedure
You will be seen in pre-operative assessment by a specialist nurse who will give you information about your operation and tell you how you should expect to feel afterwards.
You will be informed of the things you can do before, during and after your stay to help you get better sooner.
You will be given carbohydrate rich drinks to take the night before and the morning of your operation. These drinks help to keep you in a ‘fed’ state rather than a fasted state before you operation and will improve your ability to recover.
You will be admitted to hospital early in the morning on the day of your operation unless you require medical treatment the night before, such as a blood transfusion or to receive medication which you cannot take at home.
During your stay
Research has shown that active, early rehabilitation after your operation will help you to feel better sooner. Because of this, you will be encouraged and assisted to:
- move around as soon as possible after your operation
- eat and drink a normal diet, or take nutrition supplements if you are not able to eat
- have any drips, drains or catheters removed during the first couple of days of your recovery
After you leave hospital
Following your hospital stay, you will receive a follow-up telephone call from a specialist nurse at home who will make sure you feel supported and are recovering well.
We encourage our patients to give honest feedback about the care they receive, so that we can recognise areas of excellence and also identify any areas where we can make improvements.
What our patients think
Some comments we have received from patients in the care of the colorectal service since May 2011 are:
“Pre-op clinic staff were very helpful in answering questions and giving advice and support at a trying time”.
“I recovered more quickly than anticipated.”
“I didn’t think it possible to have a major operation with so little pain.”
“I felt my concerns were listened to, and everyone treated me well.”
Gynaecology
If you are undergoing a planned major procedure, the Gynaecology Enhanced Recovery Programme will direct your care. The programme aims to get you back to full health as soon as possible following your operation.
You will be given a carbohydrate drink before your operation to keep you hydrated and make sure you are in the best physical condition before, during and after surgery. These carbohydrates also prevent the feeling of sickness that sometimes follows an operation.
Although some pain is to be expected following your operation, we will aim to keep you as comfortable as possible. We will help you to start eating and drinking and we will also help you to start to move around as soon as is comfortable for you. Early mobilisation is an important part of your recovery.
Following your hospital stay, you will receive a follow-up telephone call from a specialist nurse at home who will make sure you feel supported and are recovering well.
Orthopaedic
The Orthopaedic Enhanced Recovery Programme aims to get you back to full health as soon as possible following your operation. The programme was introduced in November 2010 and was championed by Consultant Surgeon Mr Sanat Shah and Lead Physiotherapist, Justine Theaker.
Before your procedure
If you are coming into hospital for a hip or knee replacement, you will be invited to attend an education group. At the group you will learn what to expect when being admitted for your procedure. The group will also give you the opportunity to ask any questions you may have, as well as discuss with our therapy team which walking aids, or other equipment you may need following your operation. Relatives are welcome to come along to the classes.
You will be admitted to hospital early in the morning on the day of your operation, unless you require medical treatment the night before – such as a blood transfusion or medication which you cannot take at home.
After your procedure
Although some pain is to be expected following your operation, we will aim to keep you as comfortable as possible. The physiotherapy team will help you to start to move around as soon as is comfortable for you. Early mobilisation is one of the most important parts of the orthopaedic enhanced recovery programme and pain will improve by getting your new joint moving as soon as possible.
After leaving hospital, if you live in the Manchester area our therapy outreach team will visit you in the home. If you live out of the Manchester area, you will be referred to your local therapy team. Our team will still call you to check your progress.
Feedback received from our patients:
“Excellent therapy- good preparation in the education group and physiotherapists are great”.
“Pain and sickness was well controlled”.
Urology
If you are coming into hospital for a cystectomy (removal of the bladder), prostatectomy (removal of the prostate gland) or nephrectomy (removal of a kidney), the urology enhanced recovery programme will direct your care. The programme aims to get you back to full health as soon as possible following your operation.
The Enhanced Recovery team are Mr Douglas Barnes, Consultant Surgeon in Urology, Dr Umakanth Panchagnula, Consultant Anaesthetist and recently appointed Clinical Advisor to the national Enhanced Recovery Partnership Programme, and Clinical Nurse Specialist, Claire Dutton.
Before your procedure
You will receive written information which tells you about your operation and what to expect during your recovery period in hospital and at home.
You will also receive a patient diary which you can write in after your operation. Staff will use the diary to monitor and track your progress.
You will be give carbohydrate rich drinks to take the night before and the morning of your operation. These drinks help to keep you in a ‘fed’ state, rather than a fasted state before you operation and will improve your ability to recover.
You will be admitted to hospital early in the morning on the day of your operation unless you require medical treatment the night before, such as a blood transfusion or medication which you cannot take at home.
During your stay
Research has shown that active, early rehabilitation after your operation will help you to feel better sooner. Because of this, you will be encouraged and assisted to:
- move around as soon as possible after your operation
- eat and drink a normal diet, or take nutrition supplements if you are not able to eat
- have any drips, drains or catheters removed during the first couple of days of your recovery
After you leave hospital
Following your hospital stay, you will receive a follow-up telephone call from a specialist nurse at home who will make sure you feel supported and are recovering well.
We encourage our patients to give honest feedback about the care they receive, so that we can recognise areas of excellence and also identify any areas where we can make improvements.
Hepato-Biliary
The Enhanced Recovery Programme aims to get you back to full health as soon as possible following your operation.
Only a handful of hospitals in the UK currently provide the Enhanced Recovery programme in hepato-biliary (HPB) surgery. The Enhanced Recovery team is led by Mr Thomas Satyadas, Consultant HPB Surgeon, who is also an advisor to the Enhanced Recovery Partnership Programme nationally.
Before your procedure
Before your procedure, we will ensure that you are well informed and well prepared for your operation.
You will be admitted to hospital early in the morning on the day of your operation unless you require medical treatment the night before, such as a blood transfusion or medication which you cannot take at home.
You will be given a carbohydrate drink before your operation to keep you hydrated and make sure you are in the best physical condition before, during and after surgery. These carbohydrates can also prevent the feeling of sickness that sometimes follows an operation.
After your procedure
As soon as is comfortable, we will help you to get out of bed and start moving around. We will also help you to start eating and drinking as soon as possible after your operation. Nutrition is an important part of your recovery and you may need to have supplement drinks to support your diet after an operation.
During your stay
Research has shown that active, early rehabilitation after your operation will help you to feel better sooner. Because of this, you will be encouraged and assisted to:
- move around as soon as possible after your operation
- eat and drink a normal diet, or take nutrition supplements if you are not able to eat
- have any drips, drains or catheters removed during the first couple of days of your recovery
After you leave hospital
We understand that being discharged from hospital can be a worrying time and you will be contacted by a qualified nurse at home to offer support and reassurance following your operation. We encourage you to give honest feedback about the care you receive so that we can recognise areas of excellence and identify any areas where improvements could be made.
Renal Transplant
Recovering from a kidney transplant is very complex and your care will be tailored to your individual needs. The Enhanced Recovery Programme aims to get you back to full health as soon as possible following your operation and speed up your recovery where possible.
We will make sure you are well informed and supported as you prepare for your operation.
Below is an example of the daily recovery targets we would encourage patients to meet who were donating a kidney to a family member or loved one.
| Post-Op Day | Daily Targets |
| Day 0 (day of surgery) |
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| Day 1 |
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| Day 2 |
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| Day 3 |
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Patient Experience
Patients are encouraged to give honest feedback about the care they receive so that we can recognise areas of excellence and identify any areas where improvements could be made. We have a paper questionnaire that you may be asked to fill in, as well as a hand held tablet device which you may be given in the ward area or by your specialist nurse in clinic.
Reviewed ER patient experience questionnaire March 2013
Following the first year of the colorectal Enhanced Recovery (ER) pathway being introduced in May 2011, a number of patients filled out their questionnaires to tell us what they though about the care they received. This report was published in the Nursing Times in June 2013, which demonstrates the national interest and impact that patient opinions can have on practice.
Getting the measure of patient experience
Getting the measure of patient experience