The rehabilitation study, which also involved Care UK’s Shepton Mallet NHS Treatment Centre, was carried out over three months by lead physiotherapist Mini Jacob and her team. It was the focus of a presentation at the 19th annual International Forum on Quality and Safety in Healthcare at the Palais des Congrès.
The pilot explored how the average four-day hospital stay following a full knee replacement could be cut, giving patients a more active role in their own recovery and enabling them to be rehabilitated in their own homes. It followed observations that when patients were in pain, they took longer to get up and about because of the side effects of painkilling drugs, keeping them in hospital longer, and the use of general anaesthesia and nerve blocks affected their rehabilitation. They found it hard to manage rehabilitation at home; 21.93 per cent of the patients received outpatient physiotherapy.
Working on the basis that patients would work in partnership with the centre’s team, the study, called the Enhanced Recovery Programme, found that if patients understood the process before an operation, and could be up and out of bed within a few hours of their operation, they were much more confident of their ability to walk the following day. The new process meant that almost 80 per cent of patients were up and about very soon after their operation, compared with about 20 per cent previously.
Mini said: “I can see that what we have learnt in Bristol could be put into action throughout Europe and beyond. We have already fully adopted it in these two treatment centres, and Care UK is rolling it out across its other centres nationwide.”
A key part of the process was physiotherapy – patients spent two days on physiotherapy sessions and receiving direct support, before going home equipped both with planned physiotherapy sessions and a mobile phone application so that they were much more involved in their own rehabilitation and knew the milestones they needed to reach.
The changes affected every stage of the process, from the pre-operational preparation of patients, through to the use of local rather than general anaesthetics during surgery, closer pain management and swift mobilisation afterwards, to x-rays being taken more quickly after patients were up and about. Patients who might have had to stay in hospital longer because of social needs were also able to reduce their hospital stays, because those needs were addressed in the preparation stage.
Although physiotherapy follow-ups increased – from 21.93 per cent to 28.69 per cent – the length of stay fell, with some patients able to go home the day after their operation. The hospital can also now carry out more surgeries each year because the reduced length of stay makes more beds available in the ward. Reported levels of pain fell to 0.89 through the study and fewer patients needed their new joints manipulated under anaesthetic.
Mini added: “The Enhanced Recovery Programme was daunting at the start, but with the full multidisciplinary team working together from consultants, outpatients, ward and theatre nurses and ODPs to pharmacists, the programme has been successful, with satisfying outcomes in terms of patient safety, patient involvement, improved patient experience and quality of life.”