Enhanced Recovery After Arthroplasty Surgery has Resulted in Bed Day Savings and Improved Throughput

Anaesthetics and orthopaedic surgeons were using variable treatment approaches and LOS for joint replacements was longer than our national and international counterparts, however comparable to state averages.

To improve their care Toowoomba made the following changes:
• Developed a Pre/Intra/Post op analgesic regime for use by anaesthetist and orthopaedic surgeon. Included the use of local filtration. Majority of joint replacements no longer have a PCA.
• Major Orthopaedic Procedure clinic ensures patient home environment fully set-up pre-operatively
• Clear communication pre-operatively that of expected LOS of 1 – 3 days.
• Patient goal sheets developed for TKR (total knee replacement), THR (total hip replacement) and Spinal surgery to ensure patient accountable for outcomes.
• Day 0 mobilisation implemented for all patients. Not inserting IDC’s intra operatively has been a good motivator for mobilising patients.

As a result, Toowoomba has noted:
• Savings of 295 bed days ($109,150) in the 6 month for 2016 compared to 2015 for THR and savings of