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Rehabilitation
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Rehabilitation for operated lung cancer
Aim:
Develop and implement a rehabilitation programme that will improve and support the recovery of patients who have undergone curative lung cancer surgery at Heartlands Hospital. Curative lung cancer surgery removes a substantial portion of normal functioning lung to ensure clearance of cancer and the incision disrupts the chest wall. Both lead to a loss of function and reserve which puts the patient at risk of complications in and out of hospital. The baseline rate of post-operative pulmonary complications (PPC) is 15%. Once you develop a PPC, mortality increases from 0.5%to 12%, ITU admission rate increases from 1.5% to 26% and length of stay increases from 5 to 14 days.
Objectives:
The programme will identify potential surgical candidates several weeks before surgery, optimise their physical status, prepare them for the inpatient journey and support their recovery after surgery. This will include pulmonary rehabilitation, smoking cessation, dietary advice and patient self-management.
- reduced inpatient length of stay
- reduced rate of Pulmonary Complication (PPC)
- reduced ITU admissions
- increased patient quality of life
- deliver cost savings
Progress update:
The programme was evaluated with 37 patients from Solihull, Heartlands and Worcester over an 11 month period from May 2010 to April 2011. Data was compared with a non-intervention group of 155 patients over the same period.The post-operative pulmonary complication (PPC) rate was reduced from 18.7% to 11.4%.
The mean hospital length of stay (LoS) has been reduced from 7.2 days to 5.7 days.
The ITU admission rate has been reduced from 3.2% to 2.9%. In addition, the mean ITU LoS has been reduced from 3.6 days to 2 days.
On their return from surgery all patients spend at least one night in Ward 4 high dependency unit (HDU). The mean HDU LoS has been reduced from 2.4 days to 1.9 days.
The hospital re-admission rate has been reduced from 16.1% to 5.7%.
The project has delivered cost savings in the region of £44,000 over the 11 month period. £36,700 of this saving has been cash releasing to PCTs. Savings have been made through reductions in ITU and HDU admissions and hospital readmissions. There have also been savings made through reduced hospital LoS.
Patients report being motivated both before and after surgery to take an active role in their care. Staff report increased patient compliance with exercise and breathing post surgery.
Work is currently underway to ensure that the programme is available to all patients undergoing curative lung cancer surgery at Heartlands Hospital. Details on the programme and results of the testing can be found hereThe programme was also showcased on ITV Central News on the 31st October 2011 and is available to watch here
For more information on this workstream please contact James Gillies:
Mobile: 07971 197171
Email: james.gillies@westmidlands.nhs.uk