18 district health boards have introduced a new way of caring for people who need a hip or knee joint replacement or who have a fractured neck of femur (hip).
The patient-centred Enhanced Recovery After Surgery (ERAS) pathway aims to ensure people:
- are in the best possible condition for surgery
- have the best possible management during and after their operation
- participate in the best possible rehabilitation after surgery.
People recover faster and return home earlier to their normal life, work and play.
They are encouraged to be a partner in their own care. The approach starts when it is first decided a person needs surgery and continues through to their rehabilitation at home or in the community.
Elective hip or knee joint replacements
Your GP will assess your condition and discuss the best options with you, including whether to refer you to a specialist. If necessary, you will be offered healthy living advice, such as how to lose weight, stop smoking and improve your fitness.
If you are referred to a specialist and the referral is accepted, you will have a First Specialist Assessment. The specialist will discuss your condition and treatment options with you.
If surgery is right for you
If it is decided that surgery is the best option for you and you wish to go ahead with the operation, you will be given information on:
- how to prepare for your surgery
- what will happen during the operation
- what your recovery and rehabilitation will involve.
In the lead-up to your operation, you are likely to be invited to an education session where you will be given more information about your operation. These sessions are usually led by some of the clinicians who will be involved in your care, such as nurses, physiotherapists and occupational therapists. They provide a good opportunity to ask any questions you may have.
Most patients who have a hip or knee replacement stay in hospital for 3–4 days. During your stay, you will work with your health care team towards your goal of being discharged early or on time – to do this you need to move regularly, do your exercises, take pain relief and learn how to do everyday tasks, such as showering, dressing and walking up and down stairs independently.
Your rehabilitation will continue when you return home. You are likely to have several follow-up appointments either at your hospital or with your GP.
Two videos have been produced for people about to undergo hip or knee replacement surgery. These videos provide valuable advice on how you can prepare for your operation and what you can do before and after surgery to help your recovery. It also includes information on what you can expect during your stay in hospital.
Fractured neck of femur (hip)
Extra care will be taken to ensure you are comfortable, warm and don’t move around too much.
Once a diagnosis is made, clinical staff will discuss the treatment options with you.
The time spent in hospital varies for each patient with a fractured hip. Some patients may stay in hospital for rehabilitation, while others are discharged home or to a rehabilitation facility to continue their recovery in the community.
18 of New Zealand’s 20 DHBs joined a quality improvement collaborative to implement the principles of ERAS, with the 2 remaining DHBs having already started quality improvement programmes in their orthopaedic services.
Health professionals around the country are communicating with each other to share their learning and experiences.
The National Orthopaedic ERAS Collaborative formally started in November 2013 and will end in March 2015. By then it is expected that ERAS will be well established within participating hospitals and will continue as ‘business as usual’.
The National Health Board (NHB) established the collaborative after a multi-disciplinary Orthopaedic Expert Reference Group (ERG) was convened in October 2012. The ERG’s role was to advise the NHB on ways it could assist DHB orthopaedic services to reduce waiting times for First Specialist Assessments and treatment to a maximum of 4 months by December 2014.
Orthopaedics was chosen as an area to target, as it is one of the largest elective services (medical or surgical services for people who do not need to be treated immediately) and can be affected by people needing urgent operations. The focus was then narrowed to patients needing hip or knee replacements and patients with a fractured hip.
Rather than simply offering solutions to reduce waiting times, the ERG recommended the NHB establish an ERAS programme that would provide much wider benefits for patients, staff and DHBs.