Chi Sum Hannah Sung
Introduction
SWAOC was established from a former Nightingale COVID hospital as a protected elective orthopaedic surgical hub to support the NHS England elective recovery programme in Devon. It was designed as a centre for ambulatory hip and knee arthroplasty and as a “test of change” for innovative care pathways consistently
delivering day-case and short-stay joint replacement surgery.
Method
Standardised preoperative, perioperative, and postoperative pathways to ensure safe, efficient, and high-quality outcomes for high volume low complexity arthroplasty surgery were implemented. Standardisation encompassed multidisciplinary team components, including preoperative preparation, anaesthetic technique, surgical local infiltration analgesia, analgesic protocols, post-operative pathways, therapy input, and discharge medication.
Results
3183 hip and knee replacements have been undertaken since opening in 2022: 1,481 total hip replacements (THR) and 1,702 total or partial knee replacements (TKR/PKR), 857 (27%) were undertaken robotically. Day case rates are 60% THR, 62% TKR 72% UKR. Over 99% patients were discharged by day 1. 80% of patients
rate their experience as very good and 55% reported mild or no postoperative pain. The 30-day postoperative readmission rate was 2.6%, reflecting a low incidence of complications and effective care pathways.
Conclusion
SWAOC has demonstrated that by embracing best practice pathways, implementing standardised protocols and engagement of the multidisciplinary team, we can improve pain control, facilitate mobilisation and therapy engagement, and deliver the highest day case rates in the UK. In addition, pathways have been replicated in four acute sites in Devon and across the UK following engagement from 461 visitors representing 74 organisations.
Authors
Olivia Hayes, Katharine Littlejohns Royal Devon University Healthcare Foundation Trust, Exeter, United Kingdom
Dr Mary Stocker, Royal Devon University Healthcare Foundation Trust, Exeter, United Kingdom & Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom
Exeter, North Devon and Torbay Hip and Knee Teams, Royal Devon University
Healthcare Foundation Trust, Exeter, United Kingdom & Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom