Skip to content
left end
left end
right end

20 April 2018

BRI leads the way in enhanced recovery for thoracic surgery

Bristol Royal Infirmary (BRI) is leading the way in enhanced recovery to help patients to recover more quickly after chest surgery.

The hospital was the first in the country - and one of the first in the world - to offer enhanced recovery for thoracic surgery.

And the work has been so successful that now Tim Batchelor, a consultant thoracic surgeon, and Neil Rasburn, a consultant anaesthetist, are authors for the newly published international guidelines for enhanced recovery after thoracic surgery, which is the surgical treatment of chest disease such as lung cancer and collapsed lungs. Delegations from hospitals in the UK and mainland Europe have also visited the BRI to find out more about the work of Tim, Neil and their colleagues.

Tim Batchelor And Neil Rasburn

Tim Batchelor and Neil Rasburn

Enhanced recovery is a modern evidence-based approach to care which aims to ensure patients are as healthy as possible before surgery, receive the best care possible during and after their operation and also have the best experience whilst recovering.

Some of the principles of the enhanced recovery programme for thoracic surgery include:

  • Not asking patients to stop food and drink before surgery - instead they are advised to have a high energy drink two hours before an operation, the equivalent of carbohydrate loading before a marathon
  • Having a minimally invasive or "keyhole" operation
  • Encouraging patients to get up and moving soon after surgery and walking around the ward
  • Using as few tubes, drips and drains as possible
  • Giving patients an expected date of discharge (EDD) so they know what day they will be going home.

Tim said: "Patients are at the heart of our enhanced recovery programme for thoracic surgery which has so many benefits from helping patients to recover more quickly to reducing the risk of infections, complications and loss of muscle strength."

Tim and Neil, along with nursing, medical and physiotherapy colleagues, introduced an enhanced recovery programme for thoracic surgery at University Hospitals Bristol NHS Foundation Trust, which runs the BRI, in 2010.

Neil said: "Enhanced recovery is about looking at each individual part of a patient pathway and making multiple small improvements that benefit the patient and help them to recover more quickly.

"We ensure our patients know what day they will be leaving hospital as this helps them to get in the mind set of going home and as soon as possible after surgery we encourage them to get out of bed and start moving.

"Research shows that the earlier a patient gets out of bed and starts walking, eating and drinking after an operation, the shorter their recovery time will be."

Brenda Riney, from Congresbury, had enhanced recovery thoracic surgery at the BRI on 5 February 2018 after a lump was found on her lung. She returned home two days later on her expected date of discharge.

The 67-year-old great-grandmother said: "Everything has been excellent from the beginning. Everything has been thoroughly explained to me, it was really helpful to know what day I would be going home.

Brenda Riney

Brenda Riney

"I was up and walking about four hours after having my surgery and I couldn't have asked for a better experience. It's been absolutely amazing."

Tim, who is the lead author of the international guidelines for enhanced recovery in thoracic surgery published by the ERAS Society, added: "Patients are empowered from the beginning when they are referred to us as we provide all the information they need and explain what enhanced recovery involves.

 "The success of our thoracic surgery enhanced recovery programme wouldn't have been possible without the involvement of everyone on this patient pathway including pre-operative assessment staff, ward nurses, physiotherapists, anaesthetists and surgeons."