Our CWERP specialists help patients recover faster and more fully from operations.
Enhanced Recovery Programme
Teams at the Trust have developed the ‘Chichester and Worthing Enhanced Recovery Programme’ – known as CWERP – for planned hip and knee replacements, which is helping patients to feel well enough to go home far faster than was previously the case.
In the past, patients receiving routine hip and knee surgery normally spent about seven days in hospital.
They often suffered side effects following surgery, including feeling sick, which delayed their ability to mobilise as well as their overall speed of recovery.
Since CWERP has been introduced, the average stay for hip and knee patients has fallen from seven days to an average of 2-3 days. Many patients are able to go home the day after their operation. We have also successfully, safely achieved day zero discharge, with patients able to go home the same day as their operation.
The ‘enhanced recovery’ approach introduces several key changes:
‘Joint School (see videos above)’ – a two-hour session involving The Lead CWERP Practitioner, anaesthetists, physiotherapists, occupational therapists, dieticians, and specialist nurses. The patient is better informed, meaning they are more relaxed and confident to begin rehab quickly.
Anaesthetics – most patients no longer receive a General Anaesthetic, but instead have a spinal injection, along with sedation. Local anaesthetics are then injected into the joint, along with a strong combination of painkillers. This means the patient is conscious and alert immediately after surgery – and can even be conscious during surgery if they wish! – and is therefore able to recover faster, and feel better.
Rehabilitation – because patients are feeling so much better after surgery, they can begin to move far more quickly. Many are already beginning to mobilise on the day of surgery, and it is not uncommon for patients to be able to stand within three hours.
Telephone follow-up – patients are contacted by a member of the team two days after leaving. This ensures that any patient concerns can be addressed quickly, and potential problems are picked up at an early stage.
CWERP team biographies
Ian Lee – Lead Practitioner (CWERP) Senior Operating Department Practitioner (Theatre)
I am a professionally qualified Operating Department Practitioner and the Lead Practitioner for the Chichester and Worthing Enhanced Recovery Programme (CWERP) with more than 30 year’s experience in Operating Department Practice, including anaesthetics, scrub, recovery, leadership and departmental management. I trained and qualified in 1990 at Portsmouth NHS (Queen Alexandra, St Mary’s and the Royal Naval Hospital Haslar) and studied at Portsmouth University. I am a member of the Health Professions Council and the Chartered Management Institute. I have worked at St Richard’s Hospital for 12 years where I have been the Lead Practitioner for CWERP for the past 6 years. My hobbies outside work include Golf and D.I.Y.
Dr Cathryn Eitel – Consultant Anaesthetist
Since graduating from Edinburgh University Medical School in 1996, I have completed my Anaesthetic training in Scotland and London. I took up my Consultant post at St Richard’s Hospital in January 2011. Everyone here recognises my accent! My main interest lies in Orthopaedic anaesthesia, particularly joint replacement surgery, including hips, knees and shoulder replacements. I have a strong interest in Enhanced recovery after surgery, and was a lead member in the development and introduction of CWERP to WSHFT. I now lead the CWERP programme and really enjoy seeking out any improvements we can provide to our patients. CWERP is a strong team of whom I am very proud.
Vicki Hill – Data Collector for CWERP
I have worked for the NHS as a Health Care Assistant for 10 years both in the Trauma Orthopaedic Ward at Worthing Hospital & the Elective Orthopaedic Ward at St Richard’s Hospital. For the last 4 years I have collected data for Primary hip & knee replacements for the Orthopaedic CWERP team. This process of gathering & processing information is to enable the CWERP team to access & evaluate outcomes for the service in which we provide. Outside of work I love a bit of DIY, presently restoring my home & garden. I also love drawing & designing cards for all occasions.
Sarah Greer – Matron Theatre
I qualified as an enrolled nurse in 1986 at the school of nursing in Shoreham-by –Sea. I returned to Worthing hospital once my children were at school and joined the theatre team in May 2000 where I found a passion for orthopaedic surgery. In 2004 I completed a conversion course to become a registered general nurse, and then went on and completed surgical care practitioner training in 2005 in Greenwich University. I moved into the role of orthopaedic sister in theatres in 2007 and was in this role until 2016. During this time I completed a master’s degree in public sector management at Brighton business school. I then moved into the role of Matron for theatres at Worthing Hospital where I also had responsibilities for pre-assessment at Worthing and the Day Surgery unit at Southlands Hospital. In September 2018 my remit changed and I took over theatres on the St Richard’s site as well as the Worthing site and have responsibility for ensuring that we provide the highest standards of care for patients passing through out main theatres in the trust and I am consistently working with all my colleagues to see how improvements can be made.
Natalie Matthews – Senior Physiotherapist
I qualified as a Chartered Physiotherapist in 1993 at St. Marys Hospital in Paddington, London. Prior to my training I worked as a Physiotherapy Assistant at Southlands Hospital in Shoreham. My first role was as a rotational Physiotherapist at St. Richard’s where I experienced different clinical areas but I eventually specialised in Trauma and Orthopaedics in 1996 and therefore have more than 20 years expertise. At that time the Physiotherapy Team consisted of 5 members of staff but we now have 14! As Team Leader it has been very rewarding to see the service we provide grow and improve leading to better patient outcomes and experiences including the weekend service which was enhanced when the CWERP programme started in 2012.
Bob Dennes – Care Group manager Trauma & Orthopaedics
Care Group Manager Trauma & Orthopaedics since December 2017, joined Western Sussex Hospitals as Service Manager, Theatres in March 2016. Previous NHS experience as a Service Manager at Salisbury NHS FT from Jan 2010 to March 2017. Bob completed a MSc in Healthcare Leadership via NHS Leadership Academy and University of Birmingham in Jan 2017. I live on the Isle of Wight and enjoy cycling and the fairground ride of emotions supporting Portsmouth FC.
Coleen Dale – Senior Physiotherapist
After qualifying from King’s College Hospital, London in 1977, my first few years were working as a general physiotherapist in Basildon , Essex. My next 15 years were spent mainly living in Sweden and North America and when I returned to this country my first post was actually at St. Richard’s Hospital, shortly followed by a position at Spire Gatwick Park hospital where I also continue to work to this day, and then to Worthing and Southlands Hospital in 2000. In 2005 I took over the lead Physiotherapy position on a team called “Hospital at Home” which enabled hip and knee replacement patients to be discharged from hospital early and receive their care in their own homes. Length of stay has dramatically reduced over the past years but we still continue to provide rehabilitation for patients having undergone hip and knee surgery to enable them to achieve the best result postoperatively. CWERP has produced huge improvements to the patient experience and it is essential that this continues post discharge with access to dedicated rehabilitation services.
Fiona Mckeown – Senior Occupational Therapist
I qualified as a Registered Occupational Therapist in 2005 from Oxford Brookes University. I took up my first role at St Helier Hospital, London where I completed a rotation through a variety of different clinical areas gaining a wealth of experience. I then took the decision in 2008 to specialise in Trauma and Orthopaedics within a more senior position. An opportunity arose at the Naval site – Royal Hospital Haslar in Gosport. I remained working here until the hospital was closed and then transferred with the services to Queen Alexandra Hospital, Portsmouth where I remained working until 2016. Following the birth of my daughter I have had the opportunity to relocate to the Occupational Therapy department here at St Richard’s Hospital where I have taken on Team leader Role in the Orthopaedic and Surgery Team. I feel very fortunate to work not only as part of an excellent Occupational Therapy team that has genuine care and pride in the work they complete but also as part of the CWERP Team that is continually striving for improvements to patient outcomes. Outside of work I am kept very busy my very active 16 month old little girl, and we regularly enjoy outdoor walks, spending time with family and travelling.
Yvonne Thorp – Matron Trauma & Orthopaedics
Yvonne undertook her nurse training in Newcastle Hospitals and worked there for 6 months post qualifying in 1984 working on a neurosurgical ward. In July 1984 relocated to Chichester where she took a post as staff nurse night duty on General surgery. After her children were born she returned to nursing on the nurse bank working in all areas of the hospital, and then took a post on general medicine. In 1996 moved to day surgery and worked initially in pre-op assessment and recovery and then promoted to deputy sister. Implemented the nurse led discharge programme, In 2000 took post of Sister for pre-op and recovery and then in 2006 worked closely with the CTC team to plan the new centre and was Clinical Coordinator for Recovery and Pre-op assessment. In 2006 promoted to Clinical lead nurse for Elective Division this included Elective surgery, cardiac cath lab, endoscopy and clinical nurse specialists.When the divisors were reconfigured became matron for ambulatory care- 23 hour stay ward, pre-op assessment, recovery, outpatients, MFU and Ophthalmology. Implemented the cross site working of matrons in surgery. In 2015 changed to Matron for Trauma Orthopaedics and Urology. Currently Matron for Trauma and Orthopaedics- comprising Coombes and Wittering wards and Chilgrove ward.
Kari Dahl-Kingston – Senior Surgical Site Infection Surveillance Nurse
I qualified in Norway as a Nurse in 1972. I have worked in intensive care for Western Sussex Hospitals NHS Foundation Trust since 1977 until taking my current post as Senior Surgical Site Infection Surveillance Nurse and a member of the CWERP team. The Wound Care Clinic was established in 2016 which I lead, I am very passionate about the complete Patient care package that we provide including the post-operative wound care follow up service.
Steven Bird – Charge Nurse (Chilgrove Ward)
My name is Steven Bird and I am currently the ward manager on Chilgrove ward, which is the elective orthopaedic ward that cares for CWERP patients. I have been a nurse for 11 years, having qualified in November 2007. During that time I have always worked in St. Richard’s hospital, spending my first four years in Trauma Orthopaedics and the remaining time in elective Orthopaedics. I have seen how CWERP has developed over the years, from a ward and nursing perspective, and was on duty the very first day it started. My role is to manage the ward to insure effective and safe care is delivered, in line with both CWERP guidelines and objectives and those of the wider Trust. I enjoy the responsibility of the role and being a part of a progressive and evolving programme of care which CWERP provides. In my personal time I enjoy reading, Cricket, travelling and watching unintelligent superhero movies!