title: 'Am I really ready to go home?': a qualitative study of patients' experience of early discharge following an enhanced recovery programme for liver resection surgery.
abstract: Fast-track surgery or enhanced recovery programmes (ERP) have been shown to improve patient outcomes with shorter post-operative recovery times, fewer complications and more cost-effective care amongst the reported benefits. Traditionally, the effectiveness of ERPs have been assessed by measuring clinical outcomes, with the patient experience often being neglected. The aim of this qualitative study was to ascertain patients' expectations and experiences of fast-track surgery and recovery at home within the setting of an enhanced recovery programme (ERP).
  
  
  
  Twenty patients enrolled in the treatment group of the randomised controlled trial 'Enhanced recovery in liver resection surgery' were interviewed pre-operatively and 6 weeks post-surgery. Transcripts were analysed using thematic analysis.
  
  
  
  Patients approached the surgery with a sense of renewed hope. Involvement with the ERP was viewed positively, and having milestones to aim for gave patients a sense of purpose. Many felt that real recovery from surgery began at home and so felt positive about having an early discharge. Patients did report some concerns about being discharged early and those who failed to meet milestones or were readmitted to hospital experienced this as failure.
  
  
  
  This qualitative data demonstrates some of the complexities of patients' expectations and experiences of the ERP. Whilst patients generally experience the ERP positively, they also have concerns about the process. The study highlights areas where additional support may be needed for patients enrolled in ERPs and discharged early.
authors.affiliation: Faculty of Arts & Social Sciences, Kingston University, Kingston, UK. t.vandrevala@kingston.ac.uk.
authors.forename: T
authors.identifier: 0000-0002-1140-8445
authors.initials: T
authors.lastname: Vandrevala
authors.affiliation: Department of Psychology, BPP University, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Senior
authors.affiliation: Department of Hepatopancreaticobiliary Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
authors.forename: L
authors.initials: L
authors.lastname: Spring
authors.affiliation: Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
authors.forename: L
authors.initials: L
authors.lastname: Kelliher
authors.affiliation: Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Jones
mesh_terms: D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge / Q000639:trends*; D036301:Qualitative Research
keywords: Discharge from hospital; Enhanced recovery programmes; Liver cancer; Qualitative research