Home' Southern Health News : December 2016 Contents Robert Pouwels and
his wife Nada at
their family home in
Mobilising early key to good health
BY FRAN GALLARDO
Assisting patients to safely move and
walk around after oesophageal cancer
surgery has been identified as a key
success factor of a new project at
Flinders Medical Centre (FMC), reducing
the length of stay from 12 to seven days
Driven by a multidisciplinary team of surgeons,
nurses from the Intensive and Critical Care
Unit (ICCU), anaesthetists, dieticians and
physiotherapists, the aim of the project is to
assist patients to start walking and mobilising
immediately after surgery, which not only
decreases risk of complications but has seen a
remarkable 40 per cent reduction in length of
stay for patients.
Launched earlier this year, the Early Mobilisation
project was developed by surgeons Dr Tim Bright
and Professor David Watson from the FMC
Oesophago-Gastric Surgery Unit.
“The process we developed with ICCU is based
on a model of care that is performing very well
around the world,” Dr Bright said.
“We took advice from hospitals in Seattle and
the United Kingdom who first trialled the project.
It puts mobility at the centre of the patient’s
recovery from an oesophagectomy.”
According to the surgeons, by assisting patients
to slowly start moving with the help of staff,
their post-surgery complication rates are radically
reduced and their recovery enhanced.
They believe that changing the thinking in the
hospital around patients moving after surgery was
a pivotal part of the project.
“Normally after surgery, patients go to intensive
care and rest in bed for days with limited
movement, but this recovery method can
ultimately have a detrimental effect on their
health outcomes,” Dr Bright said.
“Research tells us that you lose one per cent
of strength each day you lie in bed and lose a
substantial amount of thigh muscle strength
as time goes on.”
Professor Watson said for elderly patients, a
couple of days in bed could result in several
weeks of rehabilitation.
”This can be avoided if we work together to get
patients moving out of bed safely after surgery,”
“This project is not just aiming to reduce the length of
stay. It’s about reducing complications, accelerating
recovery and improving clinical outcomes.”
FMC performs around 15 to 20
oesophagectomies in a year, making it one of
the busiest centres in Australia performing these
complex and invasive procedures. Most surgeries
are cancer related, with the average patient
being 60 to 80 years of age and diagnosed with
Robert Pouwels, 64, of Noarlunga Downs was
eager to go home after his surgery and said while
he needed a lot of support from staff and his wife
to move and walk around, he believes introducing
light physical activity was a positive part of his
“After seven days in hospital, I was ready to come
home. Home is simply a better place to recover.
My wife really helped me with everything after
surgery, especially with eating properly and
moving around the house. I couldn’t have done it
without her,” Robert said.
Professor Watson said that prior to their discharge
patients receive education about caring for their
feeding tube, taking pain relief and what their
diet should be for the first few weeks.
“We try to prepare the patient as much as possible
about recovering from this surgery in their home.
We haven’t had any serious complications that
required reintervention after the patient has gone
home,” he said.
“We understand patients would rather be
recovering in their home than hospital. If you
spend more time in hospital, there are higher
chances of infection so there are huge benefits in
going home earlier.”
The long term view is to develop the program
further to other surgical specialities.
“Any patient with major surgery who is admitted
to ICCU will see benefits if they mobilise early,”
Professor Watson said.
“Flinders Medical Centre is well placed to develop
these kinds of projects because there is a unique
cross-disciplinary culture of improving clinical
practice. This does not exist in most other
“We are able to collaborate and improve
clinical practice with the support of hospital
administration, and other departments, and this is
unusual in our hospital system.”
Changing the thinking in the
hospital around patients
moving after surgery was a pivotal
part of the project. DR TIM BRIGHT
SOUTHERN HEALTH NEWS / DECEMBER 2016 / 5
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