1. Joint School Diane Dawkins occupational therapist
Golden jubilee national hospital, Scotland

2. Enhanced recovery
“Enhanced Recovery principles promote patients and carers being partners in their own care, being more informed and having more choice about the management of their care, which improves their experience and clinical outcomes.”
Optimal patient pathways for hip and knee arthroplasties: Use of Enhanced Recovery After Surgery principles ‘’
Report from the Musculoskeletal Audit on behalf of the Scottish Government flow/enhanced-recovery.aspx

3. Enhanced Recovery Pathway – Optimising patient recovery after joint replacement

4. Pre-operative education
“Pre-operative education encourages patients to take on a central role in their recovery promoting sustainable, long-term positive outcomes” (Cooke et al 2015)
“Once education takes place, a concerted multidisciplinary effort must be made to implement even the most basic programme to ensure that patients no longer arrive at the theatre doors frightened and unaware of what will happen to them” (Garretson 2004)
Spalding (2004) found that the educational content and delivery of educational programmes gave patients a knowledge and understanding of expectations and enabled patients to feel less anxious
When we inform patients of the particulars of their surgeries, we are providing holistic care and adhering to our code of conduct

5. Policy drivers
Realising potential (2012) states it is not about doing extra, its about doing differently
Agents for Change (2012) state that Allied Health Professionals have a key contribution to make to the wider public health agenda, improving health and well- being e.g. rehabilitation services to get the best possible outcome
AHPs are the only professions expert in rehabilitation at the point of registration, their expertise in rehabilitation will be key to supporting the 2020 vision
2020 vision (2011) reports that we will respond to the needs of the people we care for, adapt to new, improved ways of working, and work seamlessly with colleagues and partner organisations and deliver a high quality healthcare service which is among the best in the world.
2020 Framework for quality, efficiency and value reports that in order to make an improvement you first must make a change
AHPs in Scotland : Active and Independent Living Programme builds on the AHP National Delivery plan

6. Objectives for joint school project
Promote Enhanced recovery
Aim of 70% of total hip and knee replacement patients attending joint school (following the MSK-pathway quality drive)
Continue to improve attendance at Joint School
Improve patient satisfaction
Improve patient information retention
Joint school project initially started in August 2014 (at pre-op assessment clinic) – one class per day

7. Joint school journey August 2014 1 class per day Lecture style
A lot of information!!!

8. Joint school journey October 2016 3 classes per day
practical demonstration
Split the hip and knee patients into different classes

9. Findings

10. The present
Above 50%
3 times per day

11. Video background Mobile communication technology is expanding globally
A patient’s greater engagement in healthcare contributes to better communication, better care, and better outcomes
Potential cost savings to NHS
While it may not replace multidisciplinary pre-operative face to face classes, the video may prove helpful as a tool to educate patients on their journey
Humans – not robots

12. The video
Aim to have 70% of patients be able to access classes prior to a hip or knee replacement by developing an innovative process of delivery
18 mins
All pre-op information included
Pain relief, hip precautions, dressing, transfers, exercises, stairs and car transfer
Shown on iPad at clinic or YouTube link
Links to current policies

13. Future plans Current format is providing positive results
Audit joint school video
Feedback questionnaire on joint school content
Maintain holistic approach
Develop app

14. Acknowledgements Emma Paxton, Physiotherapist
Deborah Davidson, Clinical Specialist Occupational Therapist
Justine Greaves, Clinical Specialist Physiotherapist

15. References
Cooke, M. Walker, R. Aitken, LM. Freeman, A. Pavey, S. Cantril, R. (2015) Pre-operative self efficacy education vs. usual care for patients undergoing joint replacement surgery: a pilot randomised controlled trial. Scandanavian Journal of Caring Science. 30 PP 74-82
Garretson, S. (2004) Benefits of pre-operative information programmes. Nursing Standard. 18 (47) pp 33-37
Scottish Government (2010) The healthcare quality strategy for NHS Scotland. The Scottish Government. Edinburgh
Scottish Government (2012) AHPs as agents of change in health and social care. The Scottish Government. Edinburgh

16. References
Scottish Government (2017) Allied Health Professions Co- creating Wellbeing with the People of Scotland. The Active and Independent Living Programme in Scotland. The Scottish Government. Edinburgh
Scottish Government (2013) A route map to the 2020 vision for health and social care. The Scottish Government. Edinburgh
Scottish Government (2013) Musculoskeletal Audit. Accessed online efficiency/whole-system-patient-flow/enhanced- recovery.aspx on 23/01/2017
Spalding, NJ. (2003) Reducing anxiety by pre-operative education: Make the future familiar. Occupational Therapy International. 10(4) PP