Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation.

Prehabilitation has been shown to improve outcomes for patients undergoing major surgery; benefits include reductions in length of hospital stay and postoperative complications. Multimodal prehabilitation programmes lead to improved patient engagement and experience. This report describes implementation of a personalised multimodal prehabilitation programme for patients awaiting colorectal cancer surgery. We aim to highlight the successes, challenges and future direction of our programme.Patients listed for colorectal cancer surgery were referred for initial prehabilitation assessment. The prehabilitation group were assessed by specialist physiotherapists, dieticians and psychologists. An individualised programme was developed for each patient, aiming to optimise preoperative functional capacity and enhance physical and psychological resilience. Clinical primary outcome measures were recorded and compared with contemporaneous controls. For those undergoing prehabilitation, a set of secondary functional, nutritional and psychological outcomes were recorded at initial assessment and on completion of the programme.61 patients were enrolled in the programme from December 2021 to October 2022. 12 patients were excluded as they received less than 14 days prehabilitation or had incomplete data. The remaining 49 patients received a median duration of 24 days prehabilitation (range 15-91 days). The results show statistically significant improvements in the following functional outcome measures after prehabilitation: Rockwood scores, maximal inspiratory pressures, International Physical Activity Questionnaire Score and Functional Assessment of Chronic Illness - Fatigue Score. There was a lower postoperative complication rate in the prehabilitation group when compared with a control group (50% vs 67%).This quality improvement project has 3 Plan-Do-Study-Act (PDSA) cycles. PDSA 1 demonstrates prehabilitation can be successfully imbedded within a colorectal surgical unit and that patients are grateful for the service. PDSA 2 provides the project's first complete data set and demonstrates functional improvements in patients undergoing prehabilitation. The third PDSA cycle is ongoing and aims to refine the prehabilitation interventions and improve clinical outcomes for patients undergoing colorectal cancer surgery.

Improving the follow-up of microbiology results: the origins of the Pink Book.

Failure to check microbiology results put patients at risk of prolonged infections, resulting in increased morbidity and mortality from sepsis. There are some electronic systems designed to address this risk although they are rarely used in the hospital setting. In many hospitals the follow-up of microbiology results for discharged patients is reliant upon individual doctor's vigilance or ad hoc lists. Our intervention, the 'Pink Book', provides a simple, cost effective system to follow-up microbiology results for discharged patients. This simple paper based system enables prompt, effective, efficient follow-up of microbiology results, saving our paediatric department an estimated 1.5 hours per week, £17,440 per year and helping to prevent one case of inadequately treated infection per month. This project highlights how small scale, simple interventions at the local level, born out of the frustration at existing inefficient systems, can make great improvements to patient safety and the efficiency of healthcare.