PERFECTED comprised four discrete but connected work packages which worked to create and evaluate the Enhanced Recovery Pathway (ERP). Using examples of best practice from across the globe, our team of national and international experts worked with patients, carers and clinicians from across five regions (East Anglia, Nottinghamshire, Yorkshire, London and Scotland) to develop and refine the ERP, creating guidelines for its use and bespoke training materials for its implementation. We conducted a pilot study in hospitals across the UK to assess the feasibility of procedures and provide data to inform a definitive trial. Patient and Public Involvement was a key component across the duration of the study both as part of the steering group and as part of Service User Advisory Groups.
This was the first dementia-specific study combining the most feasible and effective elements of best care with a formal implementation system. Based on a detailed evaluation of this pilot study, we were able to develop a definitive package for testing in a future major clinical trial.
The study was made up of four work packages:
Work Package 1 - Establishing Best Practice
(November 2013 - July 2015)
The aim of the first work package was to find out about existing practice for people with dementia who break their hip. This was carried out in several phases which included: a systematic review of research literature; surveys in England and Internationally; observations of care carried out on hospital wards and A & E; interviews and focus groups with patients, carers and professionals and the development of an initial Enhanced Recovery Pathway. Lay researchers were involved in carrying out observations in hospital, interviews and focus groups.
Work Package 2 - Optimising care for patients with dementia and hip fracture
(August 2015 - August 2016)
In this work package, we carried out Action Research, whereby the initial Enhance Recovery Pathway was trialed in ward environments. This was a process of development of the ERP to see what actually worked in real-life wards.
Work Package 3 - Pilot Study of Enhanced Recovery Pathway
(August 2016 - September 2018)
This work package was about piloting the Enhanced Recovery Pathway in a cluster randomised controlled trial, which compared the use of the Enhanced Recovery Pathway versus Usual Care. It also involved interviews and focus groups of key stakeholders. The aim was to ascertain how feasible the procedures were and to gather information which will inform a definitive trial.
Work Package 4 - Dissemination of Findings & Next Steps
(September 2020 – September 2021)
In the final work package, findings were disseminated in a variety of formats including service user outputs, peer-reviewed journal articles, a virtual IMPACT REVIEW and the launch of an updated project legacy website.
Norfolk and Norwich University Hospitals NHS Foundation Trust
Bradford Teaching Hospitals NHS Foundation Trust
Nottingham University Hospitals NHS Trust
King’s College Hospital NHS Foundation Trust
Dementia Specific Organisations
University of East Anglia
University of Nottingham
University of Leeds
King’s College London
London School of Economics
University of Edinburgh
Canterbury Christ Church University
University of the West of England
Umeå University, Sweden
Indiana University, United States
PERFECTED Team at Consensus Event London 2016
Front row bottom from left: Dr Erika Sims, Professor Fiona Poland, Dr Toby Smith, Professor Chris Fox, Dr Tamara Backhouse.
Back row top left: Professor Lee Shepstone, Mr Nick Leavey, Dr Simon Hammond, Professor Simon Donell, Dr Jane Cross, Mr tbc, Dr Nigel Lambart, Dr Bridget Penhale