The Elective Orthopaedic Team in Ward 3C at Raigmore Hospital has managed to improve patients’ surgical journeys through staff and patient education.
Enhanced Recovery After Surgery (ERAS) services, which focuses on reducing surgical stress on the body, have been reviewed and adapted in line with evidence based practice, resulting in overall benefits to patient recovery and a reduction in the length of stay for orthopaedic arthroplasty patients.
Over a period of time, the average length of stay for hip surgeries at Raigmore has reduced from three days to two days, and from four days to two days for knee surgeries. Discharges after one day are on the rise, and in the future the team hope to have a 23 hour inpatient service.
Raigmore is currently second in Scotland for day zero mobilisation, meaning patients are out of bed on the same day as their operation. Data from the week commencing 12 September 2022 showed that 100% of patients were mobilised on day zero. In 2019, only 15% of patients were mobilised on day zero. Previously mobilisation was always done by a physiotherapist, whereas now it is joined with Nurse-led mobility.
Previously sixth in the ranking, Raigmore is now first in Scotland for ERAS compliance, which is measured on four main concepts; return to food and diet on the same day post-operation, no IV fluids, no catheterisation, and day zero mobilisation for patients.
Jillian Schurei, Senior Charge Nurse in Ward 3C, said: “These statistics show great results, however, the most important aspect is the feedback from patients, who say that early mobilisation helps in several ways, including pain reduction. While we do acknowledge that sometimes there will be exceptions to these numbers, I have to commend the Elective Orthopaedic Team who have adapted and taken all challenges in their stride to improve the overall patient experience.
This wouldn’t have been possible without input from a Multi-Disciplinary Team, made up of pre-op assessment, ward nursing staff, ERAS and Arthroplasty nurses, physios and occupational therapists, consultants, and ongoing support from Kay MacGregor, our Assistant Divisional Nurse Manager.”
The development of ERAS has involved looking at ways of ensuring that patients’ expectations are managed prior to coming in for surgery. Weekly presentations and discussions for pre-op patients are held on Near-Me, NHS Highland’s virtual consultation service. The team have also collaborated with community GPs and spread awareness of the ERAS programme and Arthroplasty helpline at 27 GP practices thus far. The helpline offers an in-house review service and in turn reduces the primary care workload to free up GP appointments.
By summer 2023, the Arthroplasty and ERAS nursing team are aiming to complete their prescribing and clinical examination to further improve patient care by providing a fully comprehensive nurse-led service.
Rebecca Clark, an ERAS practitioner, is presenting on digital consultations at the ERAS UK conference in Leeds on 25 November 2022, where some of the ward team will also attend.