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Meet the team

Also:

  • Brian O’Donnell Consultant Anaesthesiologist
  • Murray Connolly Anaesthesiology SpR
  • Marie Sheehan Senior Dietitian
  • Annemarie Fitzgerald Clinical Specialist Physiotherapist
  • Gay Castles Physiotherapy Manager
  • Gayle Monahan Smoking Cessation Officer
  • Padraig Delaney Consultant Anaesthesiologist

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

We have developed a multifaceted prehabilitation programme delivered primarily over teletherapy, for patients undergoing elective major gastrointestinal surgery at Cork University Hospital (CUH).

COVID restrictions in CUH have led to the development and delivery of services via teletherapy and phone consultations in our institution. Our multidisciplinary team treating colorectal patients have grasped upon this development and the improved logistics it allows, and we have designed a pilot prehabilitation programme to be delivered primarily online and over the phone.

The development of this project has involved here-to unprecedented multidisciplinary teamwork in our institution. Our team members now include Anaesthesiologists, Colorectal Surgeons, Dietitians, Physiotherapists, Occupational Therapists, Smoking Cessation Officers and Medical Students.

What does your project aim to achieve?

Through the delivery programme we aim to improve patients’:

·                Rates of Postoperative Pulmonary Respiratory complications

·                Hospital readmission within 30 days of surgery.

·                Hospital length of hospital stay

·                Surgical site infection

·                Venous thromboembolic event

·                Cardiovascular or cerebrovascular complications including myocardial infarction, new onset arrhythmia, cerebrovascular accident, transient ischaemic attack

We hope that the delivery of our programme via telemedicine will enable a large majority of our patients to avail of the prehab services. We feel that the ability to engage with the programme from the patients’ own homes will lead to better uptake than a face-to-face programme would. CUH is a tertiary referral center for colorectal surgery for a large geographical catchment area, and the distance our patients have to travel to attend appointments can have a significant, and unequal burden on some patients. The availability of the telemedicine programme to all suitable patients should eliminate this inequality.

How will the project be delivered?

The programme will consist of six phases.

Phase One: Recruitment

Patients will recruited and consented in the surgical clinic when the decision is made to schedule them for surgery.

Phase Two: Initial Assessment

Patients’ physical, nutritional and psychological condition will be assessed by a multidisciplinary team. To reduce the patient burden, the initial assessment will be undertaken by the MDT at one visit.

Phase Three: Intervention

A three-week programme which includes nutritional advice, smoking cessation and targeted physical training will be designed for patients at high risk of adverse respiratory outcome, who are scheduled for major gastrointestinal surgery.

Phase Four: Reevaluation

Following phase three, and immediately prior to surgery, patients will be again assessed for nutritional variables, physical fitness variables and smoking variables.

Phase Five: Surgery

Surgery will be undertaken in CUH.

Phase Six: Follow-Up

Patient charts will be reviewed after 30 days and assessed for Primary and Secondary Outcomes.

How is your project going to share learning?

This pilot programme will be one of the first multifaceted prehab programmes in the Republic of Ireland. The delivery of the majority of the therapeutic elements of the project via telemedicine is also a significant development both locally and nationally.

Following delivery of our initial programme, analysis of our data, and multidisciplinary feedback and discussions we hope to both publish and present our data and experiences at national and international levels.

Given the flexible and adaptive nature of our programme, it would be very amenable to being adopted by other institutions.

We anticipate that our experiences, both positive and negative will prove to be very useful not only to us locally but also to other institutions hoping to develop similar programmes in the future.

How you can contribute

  • Feedback on the design and scope of our programme would be much appreciated. We are particularly aware that there are well developed prehab programmes in many UK institutions, and any advice would be much appreciated!

Plan timeline

1 Feb 2021 Provision of Programme to initial 30 patients

Comments

  1. Guest

    Hi,

    Can you share how you will deliver the intervention phase? Will your patients be given wearable devices etc for you to monitor HR etc and their engagement? Will the OT and smoking cessation officers link in with the patients over the 3 weeks by telephone?

    Keen to learn how you will monitor engagement. I work on the Prehab programme within Besi Cadwaladr Health Board (North Wales).. We were delivering face to face sessions 3 times per week for our patients pre the pandemic. Now looking to provide continuity of service through a virtual environment.

    Many Thanks

    Sam

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