Developing a Fast Track for patients undergoing hip and knee arthroplasty Specialist Orthopaedic Surgeon, Head of the Clinic of Orthopaedics #Quality2016 @nusjukvarden www.nusjukvarden.se/quality2016
Introduction of department What is Fast Track? Why Fast Track? Who for and by whom? How? Results? What next? Take home message
Orthopaedic department Part of Region Västra Götaland Acute and elective orthopaedic care Catchment area - 250 000 inhabitants 40 orthopaedic surgeons 5000 surgical procedures/year 550 primary hip and knee replacements Nov 2015 separated acute/elective patient flows between Uddevalla Hospital and NÄL Hospital Trollhättan
What is a Fast Track? Process oriented Clinical improvement effort Standardization of patient flows To achieve set aims Reducing hospital stay for patients Increase capacity
Why Fast Track? Mean hospital stay - 6 days Bed occupancy rate 95 % Undercapacity Long waiting period between clinical assessment and surgery (75-80% within national target) High referal rates to private clinics resulting in higher costs Need for uniformity in pre- and post-op management Low patient satisfaction in national registers Late cancellations 30 patients per year
Who for? Inclusion criteria: Diagnosis arthrosis knee and hip Primary hip and knee replacements Age 55 79 Planned surgery
and by whom? process leader (orthopaedic surgeon) process development manager ward manager orthopaedic nurse auxiliary nurse Anesthetist Physiotherapist occupational therapist secretary operating room coordinator (nurse)
How? Interventions Pre-admission preparations and social planning Comprehensive patient information leaflet Same day admission to ward or operating room theatre Adjustments to analgesia Standardized post-operative inpatient rehabilitation program
Results 50 percent reduction in mean length of stay Mean bed occupancy rate 80% Increased operating capacity (150 more cases per year) Reduced waiting times (95 100 % of patients operated within 3 months) national target Increased yearly revenue 820 000 euros (due to increased capacity to perform surgery) Reduction in late cancellations
Days 9 Mean length of stay Hip- and knee arhtroplasty 2012-2015 8 7 6 5 4 Knee Arhtroplasty 3 Hip Arthroplasty 2 1 0
Mean bed occupancy rate 2012-2015 (%) 120,00% 100,00% 80,00% 60,00% 40,00% 20,00% 0,00% 03 05 06 08 09 11 13 14 16 18 19 21 23 38 40 42 44 46 48 50 04 06 08 10 12 14 16 18 20 22 23 38 40 42 44 46 48 03 05 07 09 11 13 15 17 19 21 22 36 38 40 42 44 46 48 50 05 07 09 11 13 15 17 19 21233638 2012 2013 2014 2015
What next? Fast track became Arthroplasty process in 2015 Focus on quality indicators, PROM/PREM, quality registers, ICHOM Effects of organizational changes separation acute/elective surgery What matters to you?
Patient questionnaires SDA operating department SDA - ward 100% 100% 90% 80% 70% 78% 90% 80% 70% 60% 60% 55% 50% 40% 50% 40% 42% 30% 30% 20% 17% 20% 10% 0% 5% 0% 10% 0% 3% 0% Very Good Good Quite Good Poor Very Good Good Quite Good Poor
Did you feel well informed by orthopaedic surgeon? 100% 90% 94% 80% 70% 60% 50% 40% 30% 20% 10% 0% 6% 0% Yes, completely Partly No
100% 90% Did the information leaflet supplied to you before surgery include relevant information? 94% 80% 70% 60% 50% 40% 30% 20% 10% 0% 6% 0% Yes, completely Partly No
Take home message Work process oriented Across organizational boundaries Multidisciplinary teams are winning teams Patient involvement Separate acute and elective patient flows
Thank you! Head of department arvin.yarollahi@vgregion.se