Pre-operative education programme can reduce hospital stay for knee replacement patients

Potential to reduce NHS costs while offering more effective rehabilitation for knee replacement patients has been identified following a 20 month study carried out by academics at Northumbria University in conjunction with Gateshead Health NHS Foundation Trust. 

The collaboration between the University's Department of Sport and Exercise Science and Queen Elizabeth Hospital's Department of Trauma and Orthopaedics was led by Orthopaedic Consultant Professor Deiary Kader and supported by physiotherapist Samantha Jones and statistician Dr Mick Wilkinson.

Their work indicates that the length of time a knee replacement patient needs to stay in hospital can be reduced by around two days (one third) when a pre-operative education programme is carried out.

The reduction in length of stay through such an educational programme increases bed capacity allowing hospitals to treat significantly greater numbers of patients.  Gateshead Health NHS Foundation Trust estimates the potential to treat a further 200 joint replacement patients a year, with potential for additional income of up to £1m per annum based on the NHS tariff process.

Professor Alan St Clair Gibson, Director of Research at Northumbria University's Centre for Sport, Exercise and Wellbeing said: "Staff at the Queen Elizabeth Hospital talked to patients in advance of their operation about the process, managed their expectations and explained their rehabilitation requirements both individually and as part of group sessions and family support.  The big difference between this and other studies is that the Queen Elizabeth Hospital's pre-operative education was face to face with surgeons and a rehabilitation team, allowing patients to have immediate answers and immediate reassurance about the procedure.  We believe this made a significant difference.

"By changing the way patients are handled, managed and informed prior to this operation, and by encouraging them to play a more active role in their own post-operative recovery, it was shown that hospitals can release beds quicker, improve the patient's whole experience of being in hospital."

Orthopaedic Consultant Professor Kader added: "When we carried out this research we split our test group into two.  One group received our conventional treatment, which consisted of standard pre-operative assessment with an explanation of the procedure and consent taken in the usual way, while the other group went though our new, in-depth, pre-operative education programme.

The average stay of our conventional patients was seven days - for those trialling our new system it was five, and in twenty percent of cases even fewer.  In addition, there was no increase in the number of surgical complications or hospital readmissions.

 "I firmly believe that the implementation of an education programme like this one can, on its own, be an efficient, cost-effective method of reducing the time spent in hospital.  The work carried out here, at the hospital, I hope, will lead to a different approach to surgery preparation being used right across the country." 

One patient who has gone through this new procedure is Mr Brian Reynolds, 64, of Low Fell in Gateshead.  Mr Reynolds had his left knee replaced earlier this year by Professor Kader and was in hospital for four days.

Mr Reynolds said the support he received from the professionals at the hospital helped him considerably in his speedy recovery.

"The process has worked for me.  In February, before I had the operation, I was only able to walk at a snail's pace - now I'm back playing golf." 

He also said it helped knowing what to expect as he had his right knee replaced in Sept 2010.

However, for those going in for the first time he has additional advice. "The staff do their bit to advise and encourage you, but to get the most from that support you also need to be prepared to help yourself." 

Mr Reynolds was in hospital for four days; the national average for this type of operation is 6.6 days.

The study was published earlier this year.  In the last decade this type of surgery has doubled for first time patients and almost trebled for those having revision surgery.