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Enhanced Recovery After Surgery (ERAS) plus incorporating ICOUGH UK

Case study arrowMajor surgery particularly in the context of cancer poses a massive physiological and emotional challenge for patients and their families.

ICough logoPost-op pulmonary complications (POPC) are the most common significant complication after major surgery affecting up to 30% of patients, increasing hospital length of stay by up to 8 days as well as conveying a mortality disadvantage for years afterwards.

Recently the World Health Organisation has challenged world healthcare to improve survival in patients with cancer by 25% by 2025 and reducing patient complications after major surgery will aid us in achieving this. 

Central Manchester University NHS Foundation Trust had a primary aim to achieve a reduction in the complications rate, measuring respiratory complications at 7 days post-operatively using a multidisciplinary team incorporating the Trust’s key ERAS innovators and working with Boston Medical Centre to produce ICOUGH UK, Incentive spirometry, Coughing and deep breathing, Oral care (brushing teeth and using mouthwash  twice daily), Understanding (patient and family education), Getting out of bed at least twice daily and Head of bed elevation.  Additional innovations within the pathway included; prehabilitation and reablement tools; SURGERY SCHOOL – patient and family preparation sessions led by the multidisciplinary ERAS+ team.  Using quality improvement methodology, the ERAS+ICOUGH pathway has been embedded within the critical care nursing and medical team structure to facilitate its use with surgical patients.


  • Utilising ERAS+ within critical care in over 500 patients, has resulted in 40% reduction in pulmonary complications.
  • Empowering patients, providing multimedia resources and focussing on interventions, we believe that ERAS+ is a truly innovative approach which improves outcomes for major surgical patients.
  • Critical Care Fellowship doctors have participated providing them with excellent QI training opportunities.
  • As a group we have developed expertise in carrying out large scale transformational change.  The ERAS+ group will continue to work on similar projects within the Trust to ensure that the skills and expertise developed are disseminated locally and nationally within the NHS and potentially internationally.

Resources produced

Video: ERAS+-ICOUGHUK You Tube Channel –


Award Value: £15,881

Funding source Logo


Contact Name John Moore Email address

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