Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Spreading Enhanced Recovery After Surgery (ERAS) principles into Orthopaedics Presenter: Ian Hutchby Middlemore NZ 3-3d_HRT1215-Session_HUTCHBY_Manakau_NZ 1

KEY PROBLEM The increasing demand on resources across Counties Manukau is driving the need for continuing improvements in the way that we keep our community healthy. To meet the predicted increase in bed days, we need to give back to our community 20,000 healthy and well days, by reducing presentations and hospital bed days. Currently there are eight collaborative groups working to achieve this aim, one of which is ERAS, which aims to give back approximately 200 days by 9 am on 1st July 2013 2

AIM OF THIS INNOVATION Aim: To increase the application of enhanced recovery after surgery principles to elective surgical patients undergoing primary (hips and knees) joint replacement at Counties Manukau District Health Board. To reduce length of stay (without an increase in readmissions) To increase patient satisfaction

BASELINE DATA Average length of stay for primary hips and knees is 7 days, the introduction of EAS principles in other disciplines has shown to reduce this by at least 1 days.

KEY CHANGES IMPLEMENTED Involving the Occupational Therapy and Physiotherapy teams during the pre-admission phase, rather than only post operatively. Ensuring that a consistent Estimated Date of Discharge (EDD) is communicated by all staff to the patients throughout their journey (from pre-op clinics to post op recovery) Setting post operative goals for each day to ensure that the patient is ready to be discharged by the EDD or to flag up potential problems earlier in the recovery period

OUTCOMES SO FAR There has been a reduction in the ALOS since elements of ERAS have been introduced, although not enough for a special cause to be detected yet. Anecdotal evidence from staff comments indicates that the reduction in ALOS is likely to be more than just common variation.

LESSONS LEARNT Providing a consistent pathway which is visible to both the patient and clinicians, with daily post operative goals motivates the patients towards an earlier discharge as they know what is expected. By having daily goals an early warning sounds when they are not being met and so early intervention can be made. Having Allied Health support earlier in the process has lead to a decrease in wait times post operatively as they are already aware of the needs and also an increase in collaboration across the disciplines.