Successful ‘joint’ effort by elective surgery team

1 May 2012

A joint care clinic launched last year at Palmerston North Hospital for patients scheduled for hip and knee joint replacement surgery has proved so successful that it has been extended to include shoulder joint patients, as well.

The clinic was an initiative started two years ago by a multi-disciplinary team that covers everything that the patient needs to know, from first clinic appointment through to a safe discharge home.

Two weeks before their surgery, patients attend a two-hour information session at the hospital’s orthopaedic clinic to learn what they need to do to prepare for surgery, their hospital stay, and once they are discharged home.

During these practical sessions, nursing staff, occupational therapists, physiotherapists, and social workers inform patients about such things as: pre-surgery exercises, pain management after surgery, regaining movement after surgery, how to use crutches, correct seating height after surgery, techniques for dressing, how to correctly get in and out of a car, the likely length of stay in hospital, and the do’s and don’ts following surgery. The clinic staff use a mannequin to illustrate all the lines and other equipment a patient may wake up attached to them to take away the fear of the unknown.

Patients also receive advice on what to plan in advance – for example, time away from work (if appropriate), pre-preparing or purchasing meals, shopping, and transport home from the hospital and to physiotherapy appointments.

Where possible at the end of the session, patients can take crutches and other necessary equipment home with them, in readiness for use after their surgery.

Patients receive three joint care guide booklets: the first at the first appointment with their consultant, the second at the pre-admission clinic, and a third at the joint care clinic, reinforcing and supporting the information covered in the session.

Maria Shaw, lead clinical nurse specialist in orthopaedics, said the joint care clinic has been very successful in many areas. “One of the most encouraging aspects is that, to date, 229 patients invited to attend the clinic, have all turned up – that means a 100% attendance rate.

“We are able to identify issues early, such as wound infections, which might prevent that patient having their operation and having to be cancelled on the day of surgery. By giving us more time to assess and make these discussions early, we are able to book someone else for that position. So it is reducing theatre cancellations on the day of surgery therefore using theatres to the maximum.

She said another excellent aspect was that those patients attending the joint care clinics were, on average, spending between one and two days less in hospital – freeing up bed space for other patients.

Staff also received positive feedback from patients and relatives. One patient wrote: “I can’t speak more highly of the clinic and all the staff involved with my hip replacement.” Another said: “Great way to prepare people for surgery. Very informative, friendly, very proactive, and I was very impressed. Keep it up.”

Staff across all disciplines are also reporting a marked improvement in how patients are well prepared for their surgery and discharge.

When the clinic was mooted, Shaw said the establishment of the joint care clinic is all about supporting and involving our patients. “By providing practical information that’s given by the same team who will provide the care and support to patients during their time in hospital and after they are discharged.”

Those initial goals have been surpassed, and now other District Health Boards are also showing a keen interest.

The orthopaedic clinic was highly commended for its innovation in last year’s MDHB Health Awards.

Article contributed by MidCentral District Health Board communications