The challenges of implementing Enhanced Recovery Programme in urology


Address for correspondence: V Koo, Department of Urology, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, West Midlands SY3 8XQ, UK



Enhanced Recovery Programme (ERP) or fast-track programme involves the application of evidence-based best practice into surgery to optimize patient recovery post-operatively. Results have been very promising especially in complex surgical procedures, where patient length of hospital stay had been significantly reduced and there has not been a significant increase in patient complication or readmission rate. These favourable outcomes are potentially cost-effective for the health care team and hospital trust especially in the present economic climate. Within our department, we have recently implemented ERP in all patients undergoing radical cystectomy procedure since September 2009. In this paper, we discuss the elements of ERP, share our experiences and challenges in the implementation of ERP at different stages from prior- to post-surgery. We concluded that the key for successful implementation of ERP is the active collaboration involving the whole health care team including the nurses, nurse specialists, doctors, surgeons and anaesthetist, to ensure every team member is accountable and contribute to the implementation process. From the nursing perspective, there is a significant role to be played especially in the pre- and post-operative care of patients.