Enhanced Recovery: A Patient Centered Approach and the Five P’s

The National Health Service (NHS) in the United Kingdom has been a leading force in the development of Enhanced Recovery after Surgery programs. As the NHS succinctly states in their 2013 Improving
Quality Consensus Statement: “Quality is the driving force of enhanced recovery. Enhanced recovery improves the patient experience by getting patients better sooner, and changes clinical practice to make care safer and more efficient.”

Not surprisingly, this view aligns perfectly with the goal of University of Minnesota Health to improve quality and the patient experience of care. The Perioperative Assessment Center (PAC) has been involved for over 3 years in the development of enhanced recovery after surgery (ERAS) programs to meet this goal of improved quality. Our vision is continued development and collaborative application of quality pathways in the new M Health Fairview service line format.

The NHS noted in their Consensus Statement that a good quality pathway has many components but starts with the “5 Ps”

  • Primary Care – treating common conditions to improve “fitness for referral”
  • Patient Involvement – Invoking shared decision making with the patients
  • Prehabilitation, Assessment, and Care Planning
  • Pain relief, fluid management, and anesthetic care plan
  • Preparation for an effective discharge (and return to Primary Care)

Consistent with this view, the PAC has begun development of a more structured collaborative process with primary care physicians within University of Minnesota Health. We are looking for new ways to work together to seamlessly transition patients through the surgical experience: from their primary care physician’s office to the OR, and back to home and the care of their own physician. Our goals are an educated, empowered patient and a primary care physician who feels they are an integral part of the perioperative team.