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Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project
Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients f...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206908/ https://www.ncbi.nlm.nih.gov/pubmed/32213551 http://dx.doi.org/10.1136/bmjoq-2019-000898 |
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author | Tew, Garry Alan Bedford, Robin Carr, Esther Durrand, James William Gray, Joanne Hackett, Rhiannon Lloyd, Scott Peacock, Sarah Taylor, Sarah Yates, David Danjoux, Gerard |
author_facet | Tew, Garry Alan Bedford, Robin Carr, Esther Durrand, James William Gray, Joanne Hackett, Rhiannon Lloyd, Scott Peacock, Sarah Taylor, Sarah Yates, David Danjoux, Gerard |
author_sort | Tew, Garry Alan |
collection | PubMed |
description | Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL. A multidisciplinary, cross-sector team introduced PREP-WELL in January 2018. PREP-WELL provided comprehensive assessment and management of perioperative risk factors in the weeks before surgery. During a 12-month pilot, patients were referred from five surgical specialties at James Cook University Hospital. Data were collected on participant characteristics, behavioural and health outcomes, intervention acceptability and costs, and process-related factors. By December 2018, 159 referrals had been received, with 75 patients (47%) agreeing to participate. Most participants opted for a supervised programme (72%) and were awaiting vascular (43%) or orthopaedic (35%) surgery. Median programme duration was 8 weeks. The service was delivered as intended with participants providing positive feedback. Health-related quality of life (HRQoL; EuroQol 5D (EQ-5D) utility) and functional capacity (6 min walk distance) increased on average from service entry to exit, with mean (95% CI) changes of 0.108 (−0.023 to 0.240) and 35 m (−5 to 76 m), respectively. Further increases in EQ5D utility were observed at 3 months post surgery. Substantially more participants were achieving recommended physical activity levels at exit and 3 months post surgery compared with at entry. The mean cost of the intervention was £405 per patient; £52 per week. The service was successfully implemented within existing preoperative pathways. Most participants were very satisfied and improved their risk profile preoperatively. Funding has been obtained to support service development and expansion for at least 2 more years. During this period, alternative pathways will be developed to facilitate wider access and greater uptake. |
format | Online Article Text |
id | pubmed-7206908 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-72069082020-05-12 Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project Tew, Garry Alan Bedford, Robin Carr, Esther Durrand, James William Gray, Joanne Hackett, Rhiannon Lloyd, Scott Peacock, Sarah Taylor, Sarah Yates, David Danjoux, Gerard BMJ Open Qual Quality Improvement Report Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL. A multidisciplinary, cross-sector team introduced PREP-WELL in January 2018. PREP-WELL provided comprehensive assessment and management of perioperative risk factors in the weeks before surgery. During a 12-month pilot, patients were referred from five surgical specialties at James Cook University Hospital. Data were collected on participant characteristics, behavioural and health outcomes, intervention acceptability and costs, and process-related factors. By December 2018, 159 referrals had been received, with 75 patients (47%) agreeing to participate. Most participants opted for a supervised programme (72%) and were awaiting vascular (43%) or orthopaedic (35%) surgery. Median programme duration was 8 weeks. The service was delivered as intended with participants providing positive feedback. Health-related quality of life (HRQoL; EuroQol 5D (EQ-5D) utility) and functional capacity (6 min walk distance) increased on average from service entry to exit, with mean (95% CI) changes of 0.108 (−0.023 to 0.240) and 35 m (−5 to 76 m), respectively. Further increases in EQ5D utility were observed at 3 months post surgery. Substantially more participants were achieving recommended physical activity levels at exit and 3 months post surgery compared with at entry. The mean cost of the intervention was £405 per patient; £52 per week. The service was successfully implemented within existing preoperative pathways. Most participants were very satisfied and improved their risk profile preoperatively. Funding has been obtained to support service development and expansion for at least 2 more years. During this period, alternative pathways will be developed to facilitate wider access and greater uptake. BMJ Publishing Group 2020-03-24 /pmc/articles/PMC7206908/ /pubmed/32213551 http://dx.doi.org/10.1136/bmjoq-2019-000898 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Quality Improvement Report Tew, Garry Alan Bedford, Robin Carr, Esther Durrand, James William Gray, Joanne Hackett, Rhiannon Lloyd, Scott Peacock, Sarah Taylor, Sarah Yates, David Danjoux, Gerard Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project |
title | Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project |
title_full | Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project |
title_fullStr | Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project |
title_full_unstemmed | Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project |
title_short | Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project |
title_sort | community-based prehabilitation before elective major surgery: the prep-well quality improvement project |
topic | Quality Improvement Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206908/ https://www.ncbi.nlm.nih.gov/pubmed/32213551 http://dx.doi.org/10.1136/bmjoq-2019-000898 |
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