Developing and evaluating a new joint replacement service

At New Stobhill Ambulatory Care Hospital in Glasgow, the widespread cancellations of elective surgery brought on by the COVID-19 pandemic inspired a rapid expansion of orthopaedic services. An existing arthroplasty service for unicondylar knee replacement (UKR) was quickly adapted to also include total hip replacement (THR) and total knee replacement (TKR).

To design the new service, the team sought multidisciplinary input and were guided by Enhanced Recovery After Surgery (ERAS) principles. Some of the methods they included in their design are:

  • Pre-determined selection criteria for patients (such as ASA score or BMI).
  • Perioperative care protocols developed and adopted by the multidisciplinary team.
  • Preoperative pharmacist review and advance prescription preparation. (Click here to learn how the team implemented the preoperative pharmacy service).
  • Physiotherapist-driven same day mobilisation and safe discharge.
  • Staff training with an emphasis on adhering to ERAS ‘bundle’ of principles.
  • Follow-up telephone consults to assess patient progress.

One year after the arthroplasty service was redesigned and expanded to include the two additional procedures, the team decided to evaluate its efficacy and safety. To do this, they looked at the records of 183 patients who were seen between September 2020 and August 2021 and obtained patient feedback on the new pathway as well.

“I received very good care at Stobhill. I was very well informed from the moment I came into day surgery through to the ward. I couldn’t have received better care. I was more than happy to go home.” – Orthopaedics patient

They found that 28.4% of patients were discharged from hospital the same day as their surgery, and 89.1% were discharged by the end of the day after surgery. They also had low complication rates and few patients needed to return or be readmitted afterwards. The team has concluded that the new joint replacement service is safe and results in high patient satisfaction. As the NHS continues to recover from the COVID-19 pandemic, this orthopaedics team hopes their service will serve as an example for other orthopaedic services in ambulatory care settings. Click to view the team’s poster.