Establishing a new multidisciplinary pre-surgical optimisation service: Preliminary results
Ebrahim Bham1, Dale Edgar2,3,4, Ben Thompson4, Ellie Newman41Department of Anaesthetics, Armadale Health Service, Mt Nasura, WA, Australia2Safety and Quality, Armadale Kalamunda Group Health Service, Mt Nasura, WA, Australia3Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia4Department of Physiotherapy, Armadale Kalamunda Group Health Service, Mt Nasura, WA, Australia
Abstract
Multidimensional optimisation for surgery is not a new concept with Enhanced Recovery After Surgery well established globally. Programs are gathering momentum as keys to reduce variation in practice; post-operative complications; and, length of stay (LOS). In 2022, Armadale Health Service (AHS) launched the multidisciplinary Prehab Pathway Project (PPP), established in a non-tertiary orthopaedic joint replacement cohort.
New interventions included early triage for waitlisted patients by consultant anaesthetist and senior physiotherapist. This streamed patients into high, moderate and low risk pathways. Low risk patients received digital education packages with videos and printables, customised via responses to a comprehensive health survey. Moderate risk patients received digital education, and eligible for supervised exercise and interactive education. The PPP establishment included quarantined time for anaesthetist, physiotherapist (coordinator), dietician and admin clerks. Additional non-funded contributions included time from Executive, heads of services and nursing.
The PPP to date includes 625 cases. In the first 6 months of operation, 228 (36%) were triaged: 30% (66) high; 20% (46) moderate; 50% (116) low risk. Of the moderate risk group, 96% (44) were reviewed by a physiotherapist with 52% completing prehab exercise onsite, and the remainder receiving an individualised exercise prescription or referral to local physiotherapy. Descriptive, unadjusted outcomes for the 208 patients who had surgery, showed that mean LOS with no prehab was 3.8 (+/-4.1) dys compared to 3.2(+/-2.3) dys for those with prehab. Complication rate was similar for both groups at 15%. The PPP is ongoing and updated results and lessons learned will be presented.
Biography
A senior physiotherapist and translational researcher for over 30 years, for >20 years Dale was devoted to the specialization in provision and improvement of burn survivor and acute trauma rehabilitation in a number of Australian burns and plastic surgery (trauma) units. More recently, Dale has applied his experience and research outcomes in the development of multidimensional, preventive perioperative optimization systems for patients having surgery in both tertiary and secondary hospital contexts.