Role of Physiotherapy in the Nottingham Upper GI Post Op

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 preoperatively 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.
•Less structured
mobilisation in
early post-op
•Patients less
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
•MDT reinforce milestones and aim for joint goals
•Use of Band 3 Physio assistant to progress
•More frequent physio sessions
•Use of minimally invasive techniques and
alternative analgesia to reduce hypotension and
allow mobilisation
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.
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
•Provision of a 7 day enhanced recovery physio service.
•Patients are better
prepared for post-op
•Rapid return to
•Less respiratory
gained quicker
•Patient takes better
ownership of their
•Ready for home day
Cath McLoughlin
Clinical Lead Physio
Laura Maddison
Senior Physio
[email protected]
Reference list
available on request

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