‘Am I really ready to go home?’: a qualitative study of patients’ experience of early discharge following an enhanced recovery programme for liver resection surgery

Vandrevala, Tushna; Senior, Victoria; Spring, Laura; Kelliher, Leigh; Jones, Christopher

doi:10.1007/s00520-016-3158-6

Cited by 24 publications

(94 citation statements)

References 32 publications

(27 reference statements)

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“…Patients with sick family members, other family commitments, and those living alone were often concerned about the actual care arrangements at home, especially during early discharge. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery program versus traditional care after hepatectomy

Chen²,

Z³

et al. 2017

Medicine

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To assess the safety and efficacy of enhanced recovery after surgery (ERAS) as compared with the traditional care in patients undergoing liver surgery and optimization of enhanced recovery programs.Literature, until August 2016, was searched to identify the comparative studies evaluating preoperative hospital stay time, complications, and C-reactive protein (CRP). Pooled odds ratios (OR) or weighted mean differences (WMDs) were calculated with either the fixed or random effect model.These studies included a total of 524 patients: 254 treated with ERAS and 270 with traditional care. The postoperative recovery time and length of hospital stay were significantly better than the control group (WMD −2.72; 95% confidence interval [CI] −3.86 to −1.57; WMD −2.67; 95% CI −3.68 to −1.65, respectively). The overall complications, grade I, and Grand II–V complications were significantly favorable to the ERAS group (OR, 0.45 [95% CI, 0.30–0.67]; OR, 0.55 [95% CI, 0.31–0.98]; OR, 0.49 [95% CI, 0.32–0.76], respectively). The concentration of CRP in the control group was significantly higher than that in the ERAS group on postoperative day 5 (WMD −21.68; 95% CI −29.30 to −14.05). Time to first flatus (WMD −0.93; 95% CI −1.41 to −0.46) was significantly shortened in the ERAS group.The evidence indicates that ERAS following liver surgery is safe, effective, and feasible. Therefore, further are essential for optimizing the ERAS protocols.

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Section: Discussionmentioning

confidence: 99%

Enhanced recovery program versus traditional care after hepatectomy

Chen²,

Z³

et al. 2017

Medicine

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“…Studies with a qualitative component investigating patients’ experiences of ERAS programmes have been undertaken in CRS , gynaecological surgery and liver surgery patients . None have focused specifically on the nutritional aspects of ERAS, despite studies suggesting that their uptake may independently predict reduced length of hospital stay and risk of complications .…”

Section: Introductionmentioning

confidence: 99%

Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery: a qualitative study

et al. 2016

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AimNutrition is an important element of the Enhanced Recovery After Surgery (ERAS) programme. Patients have previously indicated that nutrition is a key component of ERAS that requires improvement. Our aim was to explore the perioperative nutrition experiences of colorectal surgical patients to identify barriers and facilitators to the integration of nutrition within ERAS.MethodSixteen individuals undergoing colorectal surgery participated in a semi‐structured interview between postoperative day three and hospital discharge. The topic guide was developed iteratively throughout the study; topics included preoperative counselling, carbohydrate loading, fasting and postoperative nutrition. A constant comparison technique was employed during coding, and an inductive thematic analysis was used. Validity was ensured by double coding a sample of transcripts.ResultsFindings are presented in the context of the following clinical themes: preoperative information, preoperative fasting, carbohydrate loading and nutritional drinks, postoperative diet and discharge. Individuals received too much general information which was repetitive, contradictory and not disease specific; this formed a key barrier affecting nutrition. Other barriers were negative experiences of nutritional drinks, stoma management, nausea and vomiting, and challenges from the hospital environment. Facilitators included interactions with staff, food accessibility and choice, and motivation for discharge.ConclusionThe key barrier to adherence of perioperative nutrition protocols was poor provision of information. Targeted information regarding postoperative diet, stoma management and coping with nausea and vomiting would be beneficial for colorectal surgical patients. Easily accessible food provided by ward staff was considered a facilitator.

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“…Patients expressing insecurities about early discharge has remained a hot and tough issue in several studies on patient experience of ERAS programme. The most common concerns were associated with pain management, mobilisation, identifying postoperative complications and lack of family support 5 15 19 20. Our patients mentioned all these concerns as well.…”

Section: Discussionmentioning

confidence: 67%

Neurosurgical enhanced recovery after surgery (ERAS) programme for elective craniotomies: are patients satisfied with their experiences? A quantitative and qualitative analysis

Liu

Wang

et al. 2019

BMJ Open

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ObjectiveTo evaluate patient satisfaction and associated predictors at discharge, as well as patient experience at 30-day follow-up, in a neurosurgical enhanced recovery after surgery (ERAS) programme.DesignA single-centre, prospective, randomised controlled study.SettingA tertiary hospital in China.ParticipantsA total of 140 neurosurgical patients aged 18–65 years old who had a single intracranial lesion and were admitted for elective craniotomy between October 2016 and July 2017 were included.InterventionsPatients were randomised into two groups: 70 patients received care according to a novel neurosurgical ERAS protocol (ERAS group) and 70 patients received conventional perioperative care (control group).Outcome measuresPatient satisfaction at discharge was evaluated using a multimodal questionnaire. A secondary analysis of patient experience regarding participation in the ERAS programme was conducted using a semistructured qualitative interview via telephone at 30-day follow-up.ResultsThe mean patient satisfaction was significantly higher in the ERAS group than in the control group at discharge (92.2±4.3 vs 86.8±7.4, p=0.0001). The most important predictors of patient satisfaction included age (OR=6.934), postoperative nausea and vomiting (PONV) Visual Analogue Scale (VAS) score (OR=0.184), absorbable skin suture (OR=0.007) and postoperative length of stay (LOS) (OR=0.765). Analysis on patient experience revealed five themes: information transfer, professional support, shared responsibility and active participation, readiness for discharge, and follow-up, all of which are closely related and represent positive and negative aspects.ConclusionsMeasures that include decreasing PONV VAS score, incorporating absorbable skin suture and shortening LOS seem to increase patient satisfaction in a neurosurgical ERAS programme. Analysis of data on patient experience highlights several aspects to achieve patient-centred and high-quality care. Further studies are warranted to standardise the assessment of patient satisfaction and experience in planning, employing and appraising the ERAS programme.Trial registration numberChiCTR-INR-16009662.

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‘Am I really ready to go home?’: a qualitative study of patients’ experience of early discharge following an enhanced recovery programme for liver resection surgery

Cited by 24 publications

References 32 publications

Enhanced recovery program versus traditional care after hepatectomy

Enhanced recovery program versus traditional care after hepatectomy

Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery: a qualitative study

Neurosurgical enhanced recovery after surgery (ERAS) programme for elective craniotomies: are patients satisfied with their experiences? A quantitative and qualitative analysis

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