NHSE DrEaMing QI Collaborative
Dr Eleanor Warwick, ST7 Anaesthetic trainee, NHSE DrEaMing collaborative core team member on behalf of the NHSE DrEaMing QI Collaborative
The Health Foundation defines quality improvement (QI) collaboratives as “A group of professionals coming together, either from within an organisation or across multiple organisations, to learn from and motivate each other to improve the quality of health services.” [1] By working together and sharing experience the aim is that teams will be motivated to improve practice based on current evidence and this will ultimately improve patient care. Working collaboratively and forming networks between health professionals and lived experience partners can help save time and resources and can support successful QI[2]. For these reasons we want to share information about an NHS England DrEaMing QI collaborative as it is a project pertinent to the whole perioperative MDT, of which anaesthetists are an integral part.
Reinvigorating Enhanced Recovery is a priority for the perioperative and critical care programme at NHS England. We know that enhanced recovery pathways are associated with improved postoperative outcomes but as pathways have become more complex and speciality specific, compliance has dropped[3]. Drinking Eating and Mobilising at 24 hours postoperatively (DrEaMing) forms a key care bundle that is intuitive and encapsulates some of the core principles of ERPs. Evidence shows that compliance with DrEaMing, either all the constituent parts or even individual aspects, can reduce length of hospital stay and reduce post operative complications[4]. There are approximately 7.8 million people waiting for surgery in the United Kingdom[5] and so initiatives that can help streamline surgical pathways have never been more pertinent. We also know that DrEaMing is important for patients; avoiding complications and recovering well is one of their key priorities whilst undergoing surgery. Patients want to be educated about care bundles like DrEaMing and understand how this ties into the expectations for their postoperative care. They also want to understand how they will be involved in ensuring they are supported to DrEaM[6].
Taking the evidence for DrEaMing and the impact QI collaboratives can have, the NHS England nursing directorate are leading a QI collaborative to support 13 participating sites successfully deliver and embed DrEaMing in all surgical specialities by September 2024. The success of this collaborative lies with true cross speciality working across the perioperative MDT and involving lived experience partners in the co-design of interventions. We know that clinical factors can influence the success of DrEaMing but so can staff related factors, organisation related factors and patient related factors[7]. It is therefore key that a multifaceted approach is taken to achieve the DrEaMing aim. Anaesthetists have an integral role in the perioperative MDT and have interactions with patients throughout their whole perioperative journey. Anaesthetists can also directly influence DrEaMing outcomes. Involving anaesthetists in DrEaMing QI, therefore, just makes good sense! DrEaMing is also currently an NHSE CQUIN[8] and a priority of the perioperative Quality Improvement Programme (PQIP)[6] which many anaesthetists may already be involved in and so linking these individual work streams together also seems sensible. While the NHSE programme is currently only working with 13 sites in England, we wanted to share information about the collaborative to promote the important message and share knowledge and learning.
How could you get involved?
1) If you work at or have one of the NHSE Collaborative sites in your Quality network, please get in touch and we can link you into the teams working on the NHSE Collaborative so efforts can be coordinated.
2) If you are working on DrEaMing QI already or thinking of starting this but do not work in one of the 13 sites, do please still get in touch. We have resources already prepared by the core team and QI experts at NHSE which may help you and we can share access to these via our NHS Futures page. In return we would love to hear the successes and challenges you have experienced on your QI journey.
3) We are looking into setting up a community of practice and this would be open to everyone. This would bring people together from across the perioperative MDT so they can share their practice and experience, learn from each other and interact regularly to support each other in improvement of care.
Resources from the NHSE DrEaMing QI collaborative.
As mentioned above, we have a selection of resources already designed and collated that could help those starting a DrEaMing QI journey or offer support for those who have started projects. These have been co-designed across speciality and with lived experience partners and with feedback from the 13 NHSE sites involved in the collaborative. Examples of these documents are: A collaborative DrEaMing Charter, a change package including driver diagrams and change ideas and a measurement package to guide QI measurement. We have also collated a literature library, a discussion forum and easy access to links to other organisations such as GIRFT and PQIP who also promote DrEaMing. We will also be sharing an iterative list of DrEaMing successes and challenges via the NHS futures pages. These resources hope to bring everything needed for DrEaMing QI into one place to help support sites, and we will continually update these resources. If you would like to join our NHS Futures pages, please get in touch.
If you have any queries please do get in touch eleanor.warwick3@nhs.net
1. Improvement collaboratives in health care - The Health Foundation.https://www.health.org.uk/publications/improvement-collaboratives-in-he… (accessed January 30, 2024).
2. Effective networks for improvement - The Health Foundation.https://www.health.org.uk/publications/effective-networks-for-improveme… (accessed January 30, 2024).
3. APOM - Getting It Right First Time - GIRFT.https://gettingitrightfirsttime.co.uk/medical_specialties/apom/ (accessed July 24, 2023).
4. Oliver CM, Warnakulasuriya S, McGuckin D et al. Delivery of drinking, eating and mobilising (DrEaMing) and its association with length of hospital stay after major noncardiac surgery: observational cohort study. British Journal of Anaesthesia 2022; 129: 114–26.
5. NHS Key Statistics: England, July 2023 - House of Commons Library.https://commonslibrary.parliament.uk/research-briefings/cbp-7281/ (accessed July 24, 2023).
6. Annual report 21-23.https://pqip.org.uk/pages/ar23 (accessed July 24, 2023).
7. DrEaMing Webinar May 2022.https://pqip.org.uk/pages/dreamweb22 (accessed January 30, 2024).
8. NHS England » 2023/24 CQUIN.https://www.england.nhs.uk/nhs-standard-contract/cquin/cquin-23-24/ (accessed January 30, 2024).
