"The AHSN proved invaluable as a networking hub and the ERP collaboratives in particular were brilliant for meeting other clinicians from across the region to share ideas, challenges and successes. ERP is now so embedded as the standard care pathway, we struggle to remember what it was like before!"
Anaesthetic Consultant

Kent Surrey Sussex Academic Health Science Network’s (KSS AHSN) Enhanced Recovery Programme (ERP) is a multimodal, evidence-based approach designed to reduce operative complications, 30 day readmissions and the length of time a patient stays in hospital, whilst also improving patient experience.

Implemented in 16 NHS hospitals and nine independent sector providers across Kent, Surrey and Sussex, ERP endeavours to improve the surgical care pathway by employing a combined total of 25 pre-operative, intra-operative and post-operative measures. Examples of these measures include:

  • Supplying a carbohydrate drink two hours before surgery;
  • Actively preventing intra-operative hypothermia with warm-air blankets or other techniques;
  • Ensuring a patient is mobilised as soon as possible post-operation;
  • Promoting early food intake.

KSS AHSN’s pathway production, data analysis and visualisation, in collaboration with the implementation of ERP measures in hospitals across KSS, have resulted in improved patient experience, reduced length of stay, and fewer patient readmissions after 30 days.

Key outcomes:

  • Complications or re-operations after colorectal surgery decreased by 25.54%
  • 30 day readmissions after colorectal surgery fell from 10.48% to 3.55% between January 2012 and December 2016
  • 73,992 surgeries conducted under the ERP surgical pathway.
Challenge / problem identified

Developed by Professor Henrik Kehlet during the 1990s, enhanced recovery programmes are an attempt to change the physiological and psychological response to major surgery (Melnyk et al., 2011). Enhanced recovery programmes are often targeted towards the fields of Gynaecology (hysterectomies), Colorectal (excision of the rectum), and Orthopaedics (hip and knee replacements).

Over recent years, enhanced recovery pathways (ERP) have become a popular method to improve quality of care, decrease length of stay, and reduce patient readmission; however, data regarding ERP is often inconsistent (Fabrizio et al., 2017).

To address this problem, KSS AHSN hosted the evidence-based enhanced recovery programme, and after implementation across KSS, there were a total of 73,992 surgeries conducted under the ERP between January 2012 and December 2016, with full implementation of the ERP measures increasing between January 2012 and December 2016 from 69.90% to 88.02%.

Actions taken

KSS AHSN has created tools to input patient ERP data, collating the data from the individual trusts and providers to produce comparative dashboards. These dashboards allow providers to analyse patient outcomes measures, and see what percentage of their patients are receiving the full ERP bundle. The dashboards are circulated every month, and each measure reveals the KSS average in order to allow providers to assess up how well they’re doing compared to others in the region.

KSS AHSN were also responsible for setting up collaborative ERP events, allowing trusts and providers to celebrate success, share stories, and refine techniques with peers within the region.

Impacts / outcomes

Patient impacts include:

  • Orthopaedic length of stay fell by 20.8% from January 2012 to December 2016
  • 30 day readmissions after colorectal surgery fell from 10.48% to 3.55% between January 2012 and December 2016
  • Complications or re-operations after colorectal surgery decreased by 25.54%
  • In December 2016, an average of 91.60% of the 25 ERP measures were completed in 73,992 surgeries. This equates to 23 of the 25 measures being carried out each surgeryEnhanced Recovery Programme


  • Through KSS AHSN’s involvement, a total of 10 acute trusts (16 hospitals) and nine independent sector providers were brought together to deliver the Enhanced Recovery Programme. Whilst the Enhanced Recovery Programme has now concluded in KSS, many members of the programme have since gone on to develop new pathways tasked with improving patient recovery, for example, the fractured neck of femur programme.

Further outcomes:

  • Implementation of the ERP’s surgical pathway resulted in the streamlining of surgical procedures by the organisations involved, resulting in patients receiving the best treatments methods more often due to care being standardised
  • A pre-operative measure was to educate patients about ERP, engaging a patient in their own recovery. This proved beneficial as it stimulated patients to take part in their own recovery by promoting speedy mobilisation and early food in-take, all measures verified to improve outcomes.
  • Clinical teams frequently received internal and external education to refresh and increase knowledge. The sharing of newfound knowledge from these clinical teams to colleagues both local and afar will improve the outcomes of patients in different wards, increasing the impact of ERP outside of this study.

 “The concept of the Enhanced Recovery Programme (ERP) is to “Do the right thing, every time for every patient”. This is something staff always aim to do and aspire to. We have enjoyed being part of the programme and making a difference to patients. We have found that ERP provides regular, focussed information to clinical staff on the delivery of key interventions which aids their understanding of how care is being delivered.”
Robin Ufton

Plans for the future

At the end of the programme, the clinical and management teams involved in ERP convened and decided that it had been embedded deep enough in the involved organisations that local monitoring would suffice in order to maintain performance. In addition, the relationships built between organisations as a result of KSS AHSN’s collaboration means the exchange of knowledge and methods continues.

Should any other region wish to implement ERP into their local trusts, KSS AHSN would be willing to share further information regarding ERP.

Which national clinical or policy priorities does this example address?
  • Quality and patient safety
  • Funding and efficiency
  • Leadership.
Start and end dates

January 2012 to December 2016.

Contact for help and advice

Project contact for further information
Peter Carpenter, Programme Director
Quality and Patient Safety Collaborative
Kent Surrey Sussex Academic Health Science Network
E: pcarpenter@nhs.net

Media contact for further information
Rick Fell, Communications Lead
Kent Surrey Sussex Academic Health Science Network
E: rickfell@nhs.net