Pioneered by Professor Henrik Kehlet in Denmark throughout the 1990s. Originated in colorectal surgery only.

. Theory: reducing both psychological and physiological impacts of surgery on the patient, ward based recovery was reduced. (Kehlet, 2009, Kehlet & Wilmore, 2008)

EBP in the 3 stages of surgery Increased MDT input Clear guidelines Auditing Reduce p/t stay and improve p/t outcomes

Counselling and training Reduced fasting Carbohydrate loading Avoidance of bowel preparations DVT prophylaxis Antibiotic prophylaxis

High flow O2 Hypothermia prevention Goal directed fluid therapy Avoidance of drains Short use of epidural pain relief Minimal incisions

Avoidance of opiates Early nutrition inc EnSures Early mobilisation Restricted I.V. Fluids Early removal of drains, catheters, NG tubes if applicable.

Post discharge call Pain control Follow up within 14days Reduce re-admission

Less paperwork!!!!! EBP Estimated bed days saved : 206,200 Estimated cost savings of 140,000-200,000. Reduced re-admissions

Increased satisfaction Reduced economical stress Reduced physical and social impacts. Increased involvement in care EBP.