Feature
Shadowing: a central component of patient and family-centred care Joanne Shaw and colleagues explain how an NHS trust incorporates the use of shadowing to improve the care experiences of patients and their families Correspondence [email protected] Joanne Shaw is assistant director of nursing for patient and family experience and service improvement Sue Pemberton is director of nursing Clare Pratt is deputy director of nursing Lisa Salter is assistant director of nursing surgery and critical care
All at Liverpool Heart and Chest Hospital NHS Foundation Trust Date submitted April 28 2014 Date of acceptance May 8 2014 Author guidelines nm.rcnpublishing.com
Abstract Patient and family-centred care (PFCC), as distinct from patient-centred, or patient-focused, care, enables healthcare organisations to work collaboratively with patients and their families to enhance and improve their care experiences. Liverpool Heart and Chest Hospital NHS Foundation Trust has implemented a PFCC model that is supported by a number of strategies including ‘shadowing’, which involves closely following patients and their families throughout their care experiences. This article briefly describes PFCC and discusses how shadowing works and the benefits of the process. Keywords Compassion, shadowing, patient and family-centred care, family and care LIVERPOOL HEART and Chest Hospital Foundation NHS Trust is committed to delivering ‘excellent, compassionate and safe care for every patient, every day’, as set out in the trust’s ‘Patient and Family Experience Vision’ document. Staff work on the principles in the vision, a standard by which all clinical and non-clinical activities are measured. The vision comprises six steps articulated in the form of a patient story that outlines patients’ and families’ journeys through the hospital, from arrival to discharge and after care; this enables staff to put patients and their families at the heart of care delivery. The trust has made significant strides towards implementing patient and family centred-care, including transforming organisational culture and
20 June 2014 | Volume 21 | Number 3
translating the concept of families as ‘visitors’ into policies, programmes and practice that support their presence and participation in day-to-day care. This ranges from family members assisting at mealtimes, through participating in rehabilitation, to staying overnight to support their loved one. The Institute for Patient- and FamilyCentered Care (IPFCC), www.ipfcc.org, an American organisation that aims to advance the understanding and practice of such care, thinks that PFCC redefines the relationships between patients, families and healthcare professionals, and is grounded in mutually beneficial partnerships. The core concepts of PFCC, as defined by the IPFCC are: ■■ People are treated with respect and dignity. ■■ Healthcare providers communicate and share ‘complete and unbiased’ information with patients and families. ■■ Individuals and families build on their strengths through participation in experiences that enhance control and independence. ■■ Collaboration between patients, families and providers occurs in policy and programme development, professional education, as well as in the delivery of care. In the UK there has been much emphasis on reports of poor care from, for example, the Commission on Dignity in Care for Older People (2012) and from Care Quality Commission (CQC) (2014) inspections that have highlighted a lack of compassion and poor communication in nursing. The chief nursing officer for England’s vision for care centres on the 6Cs – compassion, care, courage, commitment, competency and communication – and the senior NURSING MANAGEMENT
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nursing team at Liverpool Heart and Chest Hospital NHS Foundation Trust thought that these epitomised and are encompassed in the PFCC concept. Patient and family-centred care is increasing across the NHS, driven by a body of evidence by organisations such as the Health Foundation, the Picker Institute, the Enhanced Recovery Programme (Royal College of Anaesthetists 2012) and the Institute of Healthcare Improvement, as well as by patients’ voices through social media, the National Carers’ Strategy (DH 2012) and NHS Choices. The Liverpool Heart and Chest Hospital NHS Foundation Trust has a strong focus on service improvement and the desire to deliver world-class patient and family care, so it decided to develop a model for PFCC in 2010. A review of the evidence and work on implementing PFCC by other healthcare organisations, nationally and internationally, highlighted that the culture of an organisation is a driving force in creating positive patient experiences, and that moving from patient-centred, or patient-focused, care to PFCC requires cultural change. The trust therefore embarked on an innovative project that focused on improving the care experience for patients and their families. The PFCC model subsequently developed by the trust has a number of elements that support the concept, including a ‘shadowing programme’, ‘care partners’, PFCC handovers and reorganising the environment for care delivery. Care partners – who are family members or friends of patients – optimise family involvement in delivering and supporting patient care through communication and education, the provision of emotional and spiritual support, and physical care such as giving drinks and acting as safety advocates to prevent falls, for example. The PFCC handovers involve working with patients and their families as communication partners at the handover of care and transfer between areas in the hospital, while the environment for care delivery has been improved through collaboration with patients and families. For example, a new ward area has been designed with patients and families that incorporates a family room, pull-down beds in some rooms and reclining chairs in others. All of these elements support PFCC, but this article focuses on shadowing because it underpins the whole model. Shadowing involves committed, empathic observers who follow families throughout specific care experiences. Sharing patients’ and families’ experiences enables staff to observe care through NURSING MANAGEMENT
their eyes and to highlight best practice and areas that require improvement, while the information gathered through observation, discussion and analysis is used to better understand and improve care delivery. All disciplines and levels of staff are encouraged to participate in shadowing and it is included in the preceptorship process, regardless of discipline. Many of the staff who have undertaken shadowing have said that it has given them valuable insight into the experience of being in hospital and has helped them become more compassionate care givers.
Benefits of patient and family shadowing There are many benefits to patient and family shadowing. For example, it focuses on their points of view rather than the views of any particular group, care professional, hospital or clinical department. It also provides rich and accurate data that are easy to collect and timely since data collection takes place in real time and at the point of care. The process enables shadowers to ‘map’ patients’ and families’ flow of care, whether they are inpatients or outpatients and for any care experience, to see exactly where they go, and who they come into contact with at every step in the care process. Shadowing appears to inspire staff to find innovative solutions and to feel positive about changes, and helps them challenge their expectations about what is important to patients and their families. It enables them to discover examples of exemplary and compassionate care that are difficult to define, and helps develop relationships between patients, families and staff by allowing them to engage emotionally with patients’ and families’ experiences. Most importantly, shadowers can develop insights into patients’ and families’ care experiences, which promotes compassion and a deeper understanding of people’s needs. Shadowers have also reported a sense of urgency to inspire or create changes when they see care from patients’ and families’ perspectives. This can be something simple; for example, one nurse shadower noticed that the disposable briefs for surgery were small and would not fit all patients, which could be embarrassing. The nurse then researched different types of supplies and changed the order.
Staff who have undertaken shadowing have said that it has given them valuable insight into the experience of being in hospital June 2014 | Volume 21 | Number 3 21
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Feature Family members have more of a right to be with their loved ones than healthcare professionals; staff are the visitors The overall aim is for all patients and their families to experience care that is personalised to their needs and delivered professionally with compassion. Some of the benefits of shadowing are listed in Box 1.
Seven steps to shadowing The PFCC Get, Set, Go guide on shadowing (www.pfcc.org/go-shadow) describes seven steps in the process, which are described below. Define the care experience for shadowing Patient feedback at the trust is collected through a variety of sources, including hospital surveys, questionnaires, patient stories, comments and complaints and executive walkabouts, and teams can use this information to identify areas that may require a care-shadowing experience to gather real-time detailed data. Teams can also use shadowing to look at care from a fresh perspective, during an improvement project with the service improvement team, to examine or check an aspect of care, or to evaluate patient and family experiences following a change in care, environment or procedure. A care experience for shadowing can be ‘broad’ and involve a patient’s and family’s entire episode of care, from arrival through admission to discharge and rehabilitation at home, or ‘narrow’, such as a visit to outpatients or to community services. A broad care experience can be divided into sections and each section might be shadowed, while ‘narrow’ care experiences can be shadowed over shorter periods of time. Box 1 Benefits of shadowing families ■■ Can inspire staff to re-define problems, find creative solutions and feel positive about changes. ■■ Allows staff to challenge their assumptions about what they think is important to patients and families. ■■ Enables staff to develop insights into patients’ experiences, and reveals aspects of exemplary and compassionate care that are difficult to define. ■■ Helps develop relationships between patients, families and staff by enabling staff to engage emotionally with patients’ experiences. ■■ Each episode of shadowing is an opportunity for learning. 22 June 2014 | Volume 21 | Number 3
Select the patient and family shadower Shadowers require training and coaching before undertaking the process and these are provided by the trust’s service improvement team, which was integral to implementing and supporting the process. Shadowers follow patients and their families throughout their care experiences, documenting observations and gaining insight into what has gone well or surpassed expectations, and what could be improved. For this to be effective, patients and families must feel sure that the shadowers can reliably collect information and are compassionate. Any member of staff who is willing and motivated, including volunteers, students, clinicians, clerical support workers, line managers and general managers, can shadow a care experience. It is also helpful to use people who are unfamiliar with the care experiences they are observing so that they have no presumptions or bias about the care they witness. Gather the information Once the care experience and shadower have been selected, the following have to be considered: which patients and families should be shadowed, in what areas of the organisation, and at what time, based on patient volume, acuity and type of procedures involved. Connect and co-ordinate with patients and families Shadowers should make contact with patients and their families to explain the concept of shadowing and their role before beginning the exercise. Patients and families are usually willing to participate when they understand that staff are interested in improving their care experience and those of all patients and families. Contact can be made following or before admission, or staff can decide to have a ‘shadow day’ and then select a patient and family with support from the trust’s service improvement facilitator. Observe, record and evaluate patients’ and families’ care experiences Every detail of the care experience is observed and recorded as it happens as if the shadower was the patient or family member. To write a comprehensive report means the shadower has to take thorough notes and the following questions can help decide what to record: ■■ Who are the care givers? ■■ What are the touch-points the patient and family encounter? ■■ What is the care experience pathway? ■■ Where do the patient and family travel within the care setting? NURSING MANAGEMENT
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Ben Barden
■■ How long does each process take, for example how long do the patient and family spend in waiting areas or examination rooms? ■■ What are the comments, questions, and concerns they raise and at which points in the care process? ■■ What are the shadower’s impressions, observations and ideas for improvement based on the patient’s and family’s experiences and comments? Report the findings Shadowers should review their notes and ensure that they have adhered to the trust’s confidentiality guidance, which requires that patients and families are anonymous in the notes and final reports. The reports should enable readers to ‘walk in the footsteps’ of the patients and families and can include images, for example of noticeboards with out-of-date information. Reflection log Shadowers also write short reflective logs that help to identify the important learning points for them as individuals based on the insights the experiences have given them into the journeys of the patients and their families; these can be discussed with line managers in relation to personal development.
Conclusion More than 100 shadowing experiences a year are undertaken across the hospital and community sites. One of the things that hospital care teams have learned is that family members have more of a right to be with their loved ones than healthcare professionals, and that staff are the visitors. So, following discussions, set visiting times have been abolished and the trust now operates an opendoor policy. Friends and families are encouraged, in agreement with patients, to visit whenever they think is appropriate and the trust has purchased a number of beds so relatives can stay overnight. The trust has seen many changes, big and small, since 2010 when the Patient and Family Experience Vision was introduced, and collectively they have made a difference. For example, shadowing highlighted that patients going to theatre were often cold from fasting, so the trust has invested in a blanket warmer so staff can wrap patients in warm blankets if they wish them. Family members are also invited to accompany patients to the theatre forward wait area. Quarterly patient and family engagement events are held and feedback is reviewed as part of the trust’s qualitative measures. Other changes based on feedback from patients and families include NURSING MANAGEMENT
alterations to the environment; several patients who had undergone cardiac surgery said the showers were far too powerful following surgery, so the trust estates department sourced an adjustable and cheaper alternative. This project can easily be replicated in other organisations, and the approach makes a valuable difference to patients and families. The effects of introducing this model can be measured through our friends and family test scores, CQC patient survey outcomes and family experience surveys.
A nurse from Liverpool Heart and Chest Hospital NHS Foundation Trust with a patient’s relative
References Care Quality Commission (2014) Heatherwood and Wexham Park Hospitals NHS Foundation Trust. www.cqc.org.uk/directory/rd7 (Last accessed: May 12 2014.) Commission on Dignity in Care for Older People (2012) Delivering Dignity – Securing Dignity in Care for Older People in Hospitals and Care Homes. tinyurl.com/cque4ox (Last accessed: May 12 2014.) Department of Health (2012) Recognised, Valued and Supported: Next Steps for the Carers Strategy. tinyurl.com/kaphq8o (Last accessed: May 8 2014.) Royal College of Anaesthetists (2012) Guidelines for Patients Undergoing Surgery as Part of the Enhanced Recovery Programme (ERP). Helping You Get Better After Surgery. tinyurl.com/kbg6a9q (Last accessed: May 8 2014.)
Online archive For related information visit our online archive and search using the keywords.
Conflict of interest None declared
June 2014 | Volume 21 | Number 3 23
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Shadowing: a central component of patient and family-centred care Joanne Shaw and colleagues explain how an NHS trust incorporates the use of shadowing to improve the care experiences of patients and their families Correspondence [email protected] Joanne Shaw is assistant director of nursing for patient and family experience and service improvement Sue Pemberton is director of nursing Clare Pratt is deputy director of nursing Lisa Salter is assistant director of nursing surgery and critical care
All at Liverpool Heart and Chest Hospital NHS Foundation Trust Date submitted April 28 2014 Date of acceptance May 8 2014 Author guidelines nm.rcnpublishing.com
Abstract Patient and family-centred care (PFCC), as distinct from patient-centred, or patient-focused, care, enables healthcare organisations to work collaboratively with patients and their families to enhance and improve their care experiences. Liverpool Heart and Chest Hospital NHS Foundation Trust has implemented a PFCC model that is supported by a number of strategies including ‘shadowing’, which involves closely following patients and their families throughout their care experiences. This article briefly describes PFCC and discusses how shadowing works and the benefits of the process. Keywords Compassion, shadowing, patient and family-centred care, family and care LIVERPOOL HEART and Chest Hospital Foundation NHS Trust is committed to delivering ‘excellent, compassionate and safe care for every patient, every day’, as set out in the trust’s ‘Patient and Family Experience Vision’ document. Staff work on the principles in the vision, a standard by which all clinical and non-clinical activities are measured. The vision comprises six steps articulated in the form of a patient story that outlines patients’ and families’ journeys through the hospital, from arrival to discharge and after care; this enables staff to put patients and their families at the heart of care delivery. The trust has made significant strides towards implementing patient and family centred-care, including transforming organisational culture and
20 June 2014 | Volume 21 | Number 3
translating the concept of families as ‘visitors’ into policies, programmes and practice that support their presence and participation in day-to-day care. This ranges from family members assisting at mealtimes, through participating in rehabilitation, to staying overnight to support their loved one. The Institute for Patient- and FamilyCentered Care (IPFCC), www.ipfcc.org, an American organisation that aims to advance the understanding and practice of such care, thinks that PFCC redefines the relationships between patients, families and healthcare professionals, and is grounded in mutually beneficial partnerships. The core concepts of PFCC, as defined by the IPFCC are: ■■ People are treated with respect and dignity. ■■ Healthcare providers communicate and share ‘complete and unbiased’ information with patients and families. ■■ Individuals and families build on their strengths through participation in experiences that enhance control and independence. ■■ Collaboration between patients, families and providers occurs in policy and programme development, professional education, as well as in the delivery of care. In the UK there has been much emphasis on reports of poor care from, for example, the Commission on Dignity in Care for Older People (2012) and from Care Quality Commission (CQC) (2014) inspections that have highlighted a lack of compassion and poor communication in nursing. The chief nursing officer for England’s vision for care centres on the 6Cs – compassion, care, courage, commitment, competency and communication – and the senior NURSING MANAGEMENT
Downloaded from RCNi.com by ${individualUser.displayName} on Oct 05, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
nursing team at Liverpool Heart and Chest Hospital NHS Foundation Trust thought that these epitomised and are encompassed in the PFCC concept. Patient and family-centred care is increasing across the NHS, driven by a body of evidence by organisations such as the Health Foundation, the Picker Institute, the Enhanced Recovery Programme (Royal College of Anaesthetists 2012) and the Institute of Healthcare Improvement, as well as by patients’ voices through social media, the National Carers’ Strategy (DH 2012) and NHS Choices. The Liverpool Heart and Chest Hospital NHS Foundation Trust has a strong focus on service improvement and the desire to deliver world-class patient and family care, so it decided to develop a model for PFCC in 2010. A review of the evidence and work on implementing PFCC by other healthcare organisations, nationally and internationally, highlighted that the culture of an organisation is a driving force in creating positive patient experiences, and that moving from patient-centred, or patient-focused, care to PFCC requires cultural change. The trust therefore embarked on an innovative project that focused on improving the care experience for patients and their families. The PFCC model subsequently developed by the trust has a number of elements that support the concept, including a ‘shadowing programme’, ‘care partners’, PFCC handovers and reorganising the environment for care delivery. Care partners – who are family members or friends of patients – optimise family involvement in delivering and supporting patient care through communication and education, the provision of emotional and spiritual support, and physical care such as giving drinks and acting as safety advocates to prevent falls, for example. The PFCC handovers involve working with patients and their families as communication partners at the handover of care and transfer between areas in the hospital, while the environment for care delivery has been improved through collaboration with patients and families. For example, a new ward area has been designed with patients and families that incorporates a family room, pull-down beds in some rooms and reclining chairs in others. All of these elements support PFCC, but this article focuses on shadowing because it underpins the whole model. Shadowing involves committed, empathic observers who follow families throughout specific care experiences. Sharing patients’ and families’ experiences enables staff to observe care through NURSING MANAGEMENT
their eyes and to highlight best practice and areas that require improvement, while the information gathered through observation, discussion and analysis is used to better understand and improve care delivery. All disciplines and levels of staff are encouraged to participate in shadowing and it is included in the preceptorship process, regardless of discipline. Many of the staff who have undertaken shadowing have said that it has given them valuable insight into the experience of being in hospital and has helped them become more compassionate care givers.
Benefits of patient and family shadowing There are many benefits to patient and family shadowing. For example, it focuses on their points of view rather than the views of any particular group, care professional, hospital or clinical department. It also provides rich and accurate data that are easy to collect and timely since data collection takes place in real time and at the point of care. The process enables shadowers to ‘map’ patients’ and families’ flow of care, whether they are inpatients or outpatients and for any care experience, to see exactly where they go, and who they come into contact with at every step in the care process. Shadowing appears to inspire staff to find innovative solutions and to feel positive about changes, and helps them challenge their expectations about what is important to patients and their families. It enables them to discover examples of exemplary and compassionate care that are difficult to define, and helps develop relationships between patients, families and staff by allowing them to engage emotionally with patients’ and families’ experiences. Most importantly, shadowers can develop insights into patients’ and families’ care experiences, which promotes compassion and a deeper understanding of people’s needs. Shadowers have also reported a sense of urgency to inspire or create changes when they see care from patients’ and families’ perspectives. This can be something simple; for example, one nurse shadower noticed that the disposable briefs for surgery were small and would not fit all patients, which could be embarrassing. The nurse then researched different types of supplies and changed the order.
Staff who have undertaken shadowing have said that it has given them valuable insight into the experience of being in hospital June 2014 | Volume 21 | Number 3 21
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Feature Family members have more of a right to be with their loved ones than healthcare professionals; staff are the visitors The overall aim is for all patients and their families to experience care that is personalised to their needs and delivered professionally with compassion. Some of the benefits of shadowing are listed in Box 1.
Seven steps to shadowing The PFCC Get, Set, Go guide on shadowing (www.pfcc.org/go-shadow) describes seven steps in the process, which are described below. Define the care experience for shadowing Patient feedback at the trust is collected through a variety of sources, including hospital surveys, questionnaires, patient stories, comments and complaints and executive walkabouts, and teams can use this information to identify areas that may require a care-shadowing experience to gather real-time detailed data. Teams can also use shadowing to look at care from a fresh perspective, during an improvement project with the service improvement team, to examine or check an aspect of care, or to evaluate patient and family experiences following a change in care, environment or procedure. A care experience for shadowing can be ‘broad’ and involve a patient’s and family’s entire episode of care, from arrival through admission to discharge and rehabilitation at home, or ‘narrow’, such as a visit to outpatients or to community services. A broad care experience can be divided into sections and each section might be shadowed, while ‘narrow’ care experiences can be shadowed over shorter periods of time. Box 1 Benefits of shadowing families ■■ Can inspire staff to re-define problems, find creative solutions and feel positive about changes. ■■ Allows staff to challenge their assumptions about what they think is important to patients and families. ■■ Enables staff to develop insights into patients’ experiences, and reveals aspects of exemplary and compassionate care that are difficult to define. ■■ Helps develop relationships between patients, families and staff by enabling staff to engage emotionally with patients’ experiences. ■■ Each episode of shadowing is an opportunity for learning. 22 June 2014 | Volume 21 | Number 3
Select the patient and family shadower Shadowers require training and coaching before undertaking the process and these are provided by the trust’s service improvement team, which was integral to implementing and supporting the process. Shadowers follow patients and their families throughout their care experiences, documenting observations and gaining insight into what has gone well or surpassed expectations, and what could be improved. For this to be effective, patients and families must feel sure that the shadowers can reliably collect information and are compassionate. Any member of staff who is willing and motivated, including volunteers, students, clinicians, clerical support workers, line managers and general managers, can shadow a care experience. It is also helpful to use people who are unfamiliar with the care experiences they are observing so that they have no presumptions or bias about the care they witness. Gather the information Once the care experience and shadower have been selected, the following have to be considered: which patients and families should be shadowed, in what areas of the organisation, and at what time, based on patient volume, acuity and type of procedures involved. Connect and co-ordinate with patients and families Shadowers should make contact with patients and their families to explain the concept of shadowing and their role before beginning the exercise. Patients and families are usually willing to participate when they understand that staff are interested in improving their care experience and those of all patients and families. Contact can be made following or before admission, or staff can decide to have a ‘shadow day’ and then select a patient and family with support from the trust’s service improvement facilitator. Observe, record and evaluate patients’ and families’ care experiences Every detail of the care experience is observed and recorded as it happens as if the shadower was the patient or family member. To write a comprehensive report means the shadower has to take thorough notes and the following questions can help decide what to record: ■■ Who are the care givers? ■■ What are the touch-points the patient and family encounter? ■■ What is the care experience pathway? ■■ Where do the patient and family travel within the care setting? NURSING MANAGEMENT
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Ben Barden
■■ How long does each process take, for example how long do the patient and family spend in waiting areas or examination rooms? ■■ What are the comments, questions, and concerns they raise and at which points in the care process? ■■ What are the shadower’s impressions, observations and ideas for improvement based on the patient’s and family’s experiences and comments? Report the findings Shadowers should review their notes and ensure that they have adhered to the trust’s confidentiality guidance, which requires that patients and families are anonymous in the notes and final reports. The reports should enable readers to ‘walk in the footsteps’ of the patients and families and can include images, for example of noticeboards with out-of-date information. Reflection log Shadowers also write short reflective logs that help to identify the important learning points for them as individuals based on the insights the experiences have given them into the journeys of the patients and their families; these can be discussed with line managers in relation to personal development.
Conclusion More than 100 shadowing experiences a year are undertaken across the hospital and community sites. One of the things that hospital care teams have learned is that family members have more of a right to be with their loved ones than healthcare professionals, and that staff are the visitors. So, following discussions, set visiting times have been abolished and the trust now operates an opendoor policy. Friends and families are encouraged, in agreement with patients, to visit whenever they think is appropriate and the trust has purchased a number of beds so relatives can stay overnight. The trust has seen many changes, big and small, since 2010 when the Patient and Family Experience Vision was introduced, and collectively they have made a difference. For example, shadowing highlighted that patients going to theatre were often cold from fasting, so the trust has invested in a blanket warmer so staff can wrap patients in warm blankets if they wish them. Family members are also invited to accompany patients to the theatre forward wait area. Quarterly patient and family engagement events are held and feedback is reviewed as part of the trust’s qualitative measures. Other changes based on feedback from patients and families include NURSING MANAGEMENT
alterations to the environment; several patients who had undergone cardiac surgery said the showers were far too powerful following surgery, so the trust estates department sourced an adjustable and cheaper alternative. This project can easily be replicated in other organisations, and the approach makes a valuable difference to patients and families. The effects of introducing this model can be measured through our friends and family test scores, CQC patient survey outcomes and family experience surveys.
A nurse from Liverpool Heart and Chest Hospital NHS Foundation Trust with a patient’s relative
References Care Quality Commission (2014) Heatherwood and Wexham Park Hospitals NHS Foundation Trust. www.cqc.org.uk/directory/rd7 (Last accessed: May 12 2014.) Commission on Dignity in Care for Older People (2012) Delivering Dignity – Securing Dignity in Care for Older People in Hospitals and Care Homes. tinyurl.com/cque4ox (Last accessed: May 12 2014.) Department of Health (2012) Recognised, Valued and Supported: Next Steps for the Carers Strategy. tinyurl.com/kaphq8o (Last accessed: May 8 2014.) Royal College of Anaesthetists (2012) Guidelines for Patients Undergoing Surgery as Part of the Enhanced Recovery Programme (ERP). Helping You Get Better After Surgery. tinyurl.com/kbg6a9q (Last accessed: May 8 2014.)
Online archive For related information visit our online archive and search using the keywords.
Conflict of interest None declared
June 2014 | Volume 21 | Number 3 23
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