Surgical procedures can take their toll on patients in lots of different ways, whether it be physically or mentally.
That is why there are specialist roles across the NHS that focus on supporting a patient's journey to recovery before the surgery has even begun.
This type of care is known as "prehabilitation", or "pre-hab", and is the practice of providing physical and psychological support to patients prior to them being admitted to hospital.
We spoke to two members of NHS Highland's Prehabilitation Team about how it works, its role in improving patient health, how it is put into practice across the vast Highland region, what they enjoy about it, what advice they'd give to anyone starting out and what plans are in place to grow and develop NHS Highland's pre-hab services.
Felicity Turnbull is a Specialist Occupational Therapist with NHS Highland based in Inverness. She says, "The focus of my prehabilitation work is enabling and encouraging patients to be independent and safe with all aspects of activities of daily living. This can include a discussion with patients about what they can expect when they visit the hospital and during their recovery phase. This can help prepare patients both physically and mentally, while increasing their independence and confidence levels while giving them ownership over their recovery process."
Rebecca Clark is an ERAS (Enhanced Recovery After Surgery) Practitioner, also based in Inverness, and agrees. She adds, "Prehabilitation is about optimising a patient's body and mind before the operation. It could be providing advice on diet and nutrition, on habitual things like smoking or drinking as well as advice on what exercises will be most beneficial. All these aspects combined go a long way to helping reduce the patient's stay in hospital."
NHS Highland is one of the most sparsely populated Health Boards in the UK, with a population of around 320,000 people spread over 32,500 square kilometres. So how do Felicity and Rebecca provide the pre-hab care required to patients in such unique circumstances?
"Currently there is a weekly "near-me" pre-hab session," says Rebecca. "This is given to patients in the week prior to their operation and focuses on perception management and advises patients on what to expect, how to prepare their home and how their journey will progress after discharge. We're adopting technology where we can too, for example, the leaflet for this provides a QR code and we send out a reminder text with a link the day before to reduce any difficulty with access. Having it on "near-me" allows us to reach people without unecessary long journeys." Rebecca confirms that technology will continue to play an important role in delivering the highest quality pre-hab care possible across the Highlands. She adds, "We are currently discussing recording the "near-me" session and making them available online which would allow it to be accessed remotely, and repeatedly, at any time or day."
Rebecca discusses Prof. Henrik Kehlet, who developed an introduction to enhanced recovery (ERAS). Rebecca says, "Enhanced Recovery is an evidence-based approach to care. It is designed to prepare patients for, and reduce the total impact of surgery, helping them to recover more quickly. It is a multi-modal approach similar to that of care bundles."
The right prehabilitation programme could postpone an operation or even negate the need for it all together. "That's why it's so important," says Felicity. "For operations on joints such as the hip or knee, the right preparation could improve a patient's health to the point where the immediate need for surgery reduces or disappears." Rebecca adds, "This then has a knock-on effect too, in that it will help reduce surgery waiting lists."
It is this positive impact on people's lives and wellbeing that provides a source of fulfilment and job satisfaction for both Felicity and Rebecca.
"From an Occupational Therapists perspective, you're improving someone's quality of life," says Felicity. "By reducing their pain, you are allowing them to be more independent, giving them a new lease of life. It's really satisfying to have such a positive impact on someone who has been struggling."
Rebecca adds, "If a patient's length of stay at hospital is reduced, it means higher bed turnover, meaning more operations can go ahead quicker, improving the quality of life and wellbeing for even more patients."
Improving patient's quality of life in such a way requires a collaborative and interconnected working environment and multi-disciplinary team working. This is another aspect of working with NHS Highland on prehabilitation that Rebecca and Felicity enthuse over.
Felicity asserts, "We have an integrated and cohesive way of working across departments in NHS Highland which makes supporting patients more effective and ultimately assists with the positive experience for patients."
Rebecca agrees and comments, "Our teams work very well together and there is always opportunity to learn from each other and establish a team made up of different specialism's depending on a patient's needs, such as occupational therapy and physiotherapy."
The implementation of pre-hab is still somewhat in it's infancy across the NHS and Felicity and Rebecca, along with their NHS colleagues in the Highlands and the rest of Scotland, are keen to share knowledge and best practice wherever possible. Rebecca says, "My first encounter of pre-hab was the "Best in Class" approach undertaken by Clackmannan which was associated with a reduction in Orthopaedic referrals. NHS Fife provides prehabilitation pages online, for all specialities, while NHS South Tees have a similar approach which combines online education with physical classes. We have prior permission to use some of these resources so we can learn from these to offer patients in the NHS Highland region the absolute best pre-hab care possible."
Felicity and Rebecca recommend anyone interested in taking up a career in caring for others to consider being involved in rehabilitation. "Orthopaedics is a very satisfying field to be involved in. It can be instantly gratifying having a person that was on bedrest walk with you," says Rebecca.
"With pre-hab, a part of the job is problem-solving, which can be exciting," adds Felicity. "You are getting involved with a patients journey at a stage where they are struggling and being able to assist and increase a patients quality of life before something goes wrong or gets worse. No two days tend to be the same, and you get to meet and work with such a wide range of enthusiastic and talented people. That's really enjoyable and satisfying."
Felicity and Rebecca go on to describe the work that has been started for pre-hab as an "exciting journey" which will "increase and encourage a more holistic approach to patient care through multi-disciplinary working."
Felicity surmises the role of prehabilitation and says, "The journey will ultimately increase an individual's quality of life and wellbeing through enabling patient ownership and independence of their activities of daily living."