Redesign of joint replacement care pathway

Ms Rosemary Morgan1, Miss Laura Bowman1

1Southwest Healthcare, Warrnambool, Australia

Aim: To have a consistent pathway of care for joint replacement patients that resulted in a reduced length of stay, better outcomes for clients through intervention both pre- and post-surgery, and increased efficiency for the hospital.

Method:

Analysis of strengths and inefficiencies of the existing pathway, through consultation with all key stakeholders. Support from Orthopaedic Team was essential.

In September, 2014, prior to implementation, Southwest Healthcare demonstrated a significant wait list and a mean length of stay of 7-10 days. They received one session of Allied Health intervention prior to surgery, and were seen once daily on weekdays during admission.

The new pathway consists of pre-habilitation appointments every 3 months for active exercise and education whilst on the wait list. Whilst an inpatient, clients receive twice daily physiotherapy, seven days a week, aiming for a 4 day length of stay. Clients having morning surgeries are mobilised on the same day. An expansion of the Subacute Ambulatory Care Service (SACs) services also includes review within 10 days of discharge and weekly attendance of group therapy.

Results: All patients on the elective waiting lists have been reviewed in the pre-operative rehabilitation clinic. 80% of patients were successfully mobilised on day of surgery. Data demonstrates in both populations a consistency in reduction of median LOS to 4-5 for hips and 5-6 days for knees.

Significance of findings for Allied Health: Increased Allied Health intervention demonstrated a saving of 186 bed days per year (capacity for 32 additional joint replacements), and unreservedly demonstrated our value organisation-wide.