Fast-track rehab program has accelerated and improved post-joint replacement care

VIENNA — A new “very fast-track” rehabilitation program used in total joint replacement patient care programs at Vejle Hospital, in Denmark, has reduced most patients’ hospital lengths-of-stay to about 2 days and generally streamlined joint replacement surgeries and the strategies for managing them.

Key components of the program that distinguish it from those previously in place at the hospital and elsewhere in Europe, include enhanced surgical techniques such as 10-cm incisions for total hip replacement (THR), using a variety of implants and administering optimal postoperative pain management that permits mobilizing patients the day of surgery, according to Per Kjaersgaard-Andersen, MD.

Fast mobilization is now possible in 90% of cases, he said.

“Our goal is to only have stays for the period necessary,” Kjaersgaard-Andersen said during a symposium held here at the 10th European Federation of National Associations of Orthopaedics and Traumatology Congress (EFORT). He is Chief Medical Editor of Orthopaedics Today Europe.

The concept for the program Kjaersgaard-Andersen discussed was introduced by industry partner, Biomet, but the need to perform more cases with fewer resources was identified earlier by Vejle hospital’s owner and others. The program follows two earlier efforts at the hospital: standard and regular fast-track rehabilitation programs, which both led to hospital-wide improvements.

However, this new fast-track program has involved making improvement-related changes that impact the patients, nurses and other hospital staff members, Kjaersgaard-Andersen explained.

What made this program so successful compared to its predecessors is that it created a team spirit and everyone is positive, not just the doctors, he said.

Patients involved

For patients, this has meant providing them with more information prior to their THR or total knee replacement surgery. For example, patients scheduled for a THR on a Monday attend an information session with their family members on the previous Wednesday where they learn more about the surgery, view a procedure-related video and see a patient who underwent THR 2 days earlier.

Having the surgeon and staff discuss with the patient, in advance, when they should expect to be discharged has also made a difference in helping reduce length-of-stay and it makes them part of the team.

“If you tell the patient exactly what day he or she has to go home, he or she goes home on that day,” Kjaersgaard-Andersen explained.

Nurses’ role

An equally important change in the nurses’ role in post-THR care took place with implementation of the new program. They now handle the pain management program in its entirety and also monitor each patient’s physical therapy sessions.

Where earlier policies at the hospital required a doctor see the patient before he or she could be discharged, a nurse can now decide when a patient can go home.

“We learned everyone has to do everything,” Kjaersgaard-Andersen said, noting that the only exception to this concept is the surgical procedure itself. “It is still in the hands of the surgeons.”

Making a difference

A key goal for the program in 2009 is to complete 500 total joint replacement surgeries.

“It will be interesting to see the effect it has on orthopaedics in the future,” Kjaersgaard-Andersen noted.

The new fast-track program is being used in other hospitals in Denmark. It has also been studied by hospital personnel in Norway and elsewhere, he said.

Reference:
Kjaersgaard-Andersen P. Challenges when increasing the numbers of joint replacements six-fold during six years. Introducing fast track rehabilitation program. Presented at the 10th EFORT Congress. 3-6 June 2009. Vienna.