Abstract
Background: Several hospitals within the NHS now run specialist teams that look after assisted discharge plans for patients following elective surgeries. Joint replacements form a significant segment of elective majors in orthopaedics. In the second half of the last year alone, the National Joint Registry estimated that there were over 100,000 joint replacements carried out within England and Wales. Such schemes are designed to: 1. Enable patients to be discharged to their home as quickly and safely as possible, to maximise recovery and rehabilitation. 2. Ensure the most effective use of acute orthopaedic beds. 3. Reduce risks of hospital acquired infection 4. Streamline inpatient care so as to positively impact upon inpatient and outpatient waiting times. There is scarce information available about the experience of NHS hospitals with such schemes.
Aims And Objectives: 1. Investigate patient expectations of and satisfaction with discharge planning on the early discharge scheme. 2. Assess areas of concern to the patient and difficulties encountered by the patient in the home environment. 3. Improve our understanding of patient requirements, functional recovery and planning of discharge. 4. Investigate whether our lengths of stay compare with others in the NHS/literature and what factors are influencing the figures. 5. Investigate overall success of the scheme.
Patient And Methods: The study identified 100 consecutive patients who have had joint replacement surgery after August 2003 and have been discharged under the scheme. A Patient Satisfaction Questionnaire was used and the patients completed different sections at discharge and then at about six. Notes were reviewed for any complications or problems.
Conclusions: The scheme to discharge patients early is highly successful and well received by staff and patients. All consultants now use the service and the initial aims have been met, saving approximately 335 bed days in the first six months. The average inpatient stay has been reduced by half in the last 18 months. 98% of patients stated that the scheme met their needs. The majority of comments were positive. Only two patients needed readmission within the first fortnight from discharge, one with a dislocated hip and the other was a knee with wound infection. There were two complaints, which were deemed serious enough for a mention.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
