Dr. Duncan Jacks wanted to make it possible for patients coming into the hospital for hip and knee surgery to return home on the same day. This is made possible by advancement in surgical techniques and better perioperative pain protocols but has not yet been the practice in Victoria. Getting patients home safely on the same day as their surgery is not only better for patients – it frees up hospital beds for other patients and leads to substantial cost savings for Island Health.
Developing and implementing a pilot for outpatient arthroplasty required cooperation and engagement across multiple disciplines and departments to establish a protocol that met the needs of all participating departments and ensured good quality control. Over the past year, with the assistance of a grant from the South Island Medical Staff Association, Dr. Jacks brought together orthopaedic surgeons, anaesthesiologists, Clinical Nursing Leads in the operating room, PACU, ward, and outpatient Rebalance clinic, pharmacists, physiotherapists, MOAs, and Island Health Directors to establish a successful protocol to enable hip and knee replacement patients to safely go home on the day of surgery.
The group knew that other centers in Canada were performing same-day discharge for Arthroplasty. They traveled to Montreal in December 2018 to view that facility’s processes and protocols, and witness first-hand the experience of patients having their surgeries and discharge on the same day.
Upon return to Victoria, the group started recruiting people from different disciplines to form a smaller working group to see how their protocols could be applied to Victoria’s set up. Once they were satisfied with the protocols, they set about designing a pilot. Eight patients participated in the pilot and provided constructive feedback on their experiences. After these debriefs, the group met again to discuss the feedback and make necessary adjustments, and refine handouts for patient education.
The project has now successfully sought Phase 2 funding to support the engagement of other orthopaedic surgeons and anesthesiologists to scale up this project and apply it to all patients, as well as look at resource requirements and cost savings. Speaking about the value of the funding, Dr. Jacks said “It would have been impossible to do this project without this funding. It’s a lot of ‘volunteer time’ on the part of physicians, often after-hours or early mornings, so I think it really enables us to move forward with this project knowing that there is funding set aside for people’s time”. He reiterated that there was “huge value with different players sharing key ideas for every step of the protocol”.
We look forward to seeing what happens with this promising endeavor in Phase 2!