Ms Sarah Bright1, Mr Brendan Dawes1
1Monash Health – Monash Medical Centre Clayton and Moorabbin Hospitals, Clayton, Australia
Biography:
Sarah Bright is the Manager of Occupational Therapy at Monash Medical Centre, Moorabbin Hospital and the Victorian Heart Hospital. Sarah has around 18 years of clinical experience and 7 years of management experience, and has completed a Master of Public Health. Brendan Dawes is a Senior Physiotherapist specialising in orthopaedics, has over 9 years clinical experience and has completed post graduate studies in Health Management. Sarah played a key role in leading the orthopaedic reform work, and Brendan acted as the Allied Health lead in implementing the elective surgery reform changes post COVID pandemic.
Abstract:
Purpose:
To improve patient engagement, reduce acute length of stay (LOS) and the need for inpatient rehabilitation for elective total hip and knee replacement (THR/TKR) patients.
Nature/Scope:
The COVID Pandemic had a significant impact on the elective surgery waitlist for THR/TKR at Monash Health. The goal was to streamline care by enhancing patient pathways from pre-admission to discharge, focusing on patient preparedness for surgery, reduced LOS and timely access to community rehabilitation (CR).
Issue/Problem:
Pre-operative planning for elective THR/TKR lacked patient involvement, these patients experienced extended LOS in acute and subacute wards, impacting patient flow and access. In addition, there were long wait-times for CR access.
Intervention:
The pre-admission clinic (PAC) was revamped to prioritise patient engagement, with LOS agreed upon by senior clinicians and patients utilising the RAPT tool. Early CR referrals were introduced to minimise wait-times, and Allied Health (AH) staffing was increased on weekdays and weekends on acute wards for more frequent interventions. An extended acute LOS for Pathway C patients of 7-10 days was trialled and successfully implemented to avoid subacute admissions.
Outcomes:
100% of patients agreed to a planned LOS. Increased AH frequency on acute wards led to a significant reduction in LOS for all THR/TKR patients with Pathway C showing the greatest benefit. Pre-intervention, only 20% of Pathway C patients were discharged home directly from acute care, rising to 83% post-intervention. This saved 1,387 subacute bed days annually. 85% of patients were satisfied with the extended LOS and avoiding subacute care.