Transforming Ontario's Health Care System Care Stories

Improving patient experience by focusing on recovery from start to finish

From pre-op through post-op, Southlake Regional Health Centre is focused on supporting the speedy recovery of hip and knee surgery patients.

Patients attend 'hip and knee school' a few weeks before their surgery where they meet with a physiotherapist, nurse, occupational therapist and other health care professionals so they fully understand the journey. They learn what to expect before and after surgery, are shown exercises to help recovery and told about equipment to support them at home. Southlake is in the process of putting its school online so patients who can't attend in person have access.

"We encourage family members to participate so they can act as coaches and advocates and help with recovery," said Dayton Dysart, a physiotherapist who leads the sessions.

Leslee Beatty, Southlake's Manager of the Musculosketal Unit, said it is essential for her multidisciplinary team to be focused on supporting patients to go home as soon as possible. Staffing schedules were rearranged to ensure physiotherapists work on weekends, avoiding recovery delays for patients who have surgery late in the week.

"Team members follow a care plan. We are well integrated and everything is done to support discharge at the time that's right for the patient," Beatty said. "The minute you arrive on the floor the discharge planning has already begun," added Elizabeth Birch, discharge nurse.

"The entire team, not just the physiotherapist, is focused on getting patients mobile on the first day - even if it's getting them sitting up in bed," Dysart noted.

Between the first and fourth quarters of fiscal 2012-2013, lengths of stay (LOS) for hip and knee surgical patients declined from 5.4 days to 3.4 days and the percentage of patients discharged directly home increased from :

  • 72 per cent to 88.9 per cent for hip replacement patients
  • 81.9 per cent to 92.3 per cent for knee replacement patients

These improvements were achieved with no significant changes in readmissions or complications to wound healing.

The goals of Health System Funding Reform led Southlake to set a high bar for itself to improve outcomes for its hip and knee surgery patients, while increasing its efficiency in delivering care said Barb Steed, Southlake's Director of Surgery.

To achieve significant change, the hospital's leaders sought the buy-in of a cross-section of health professionals – both within and beyond the institution.

"We started a conversation encouraging the sharing of ideas. Nothing was off limits," orthopedic surgeon, Dr. Tom Bertoia said. The dialogue expanded to include other hospitals throughout the Central Local Health Integration Network (LHIN).

"We looked at the variances in lengths of stay for patients among our five surgeons, then at more than 20 surgeons at other hospitals. We had a big group to draw from to show how we could do things more efficiently," Dr. Bertoia said.

Many clinicians were taken aback when one hospital proposed reducing the length of stay for hip and knee replacement surgery patients from an average of five days to just three–lower than the provincial target of 4.4 days.  "It seemed like a difficult target, but it became a LHIN-wide challenge that everyone embraced," Dr. Bertoia said.

Southlake set clear targets to reduce length of stay (LOS) for its hip and knee patients and to increase the percentage of these patients who were discharged directly home. "We made many changes across the organization that supported patient recovery and resulted in reducing length of stay," Steed said.

"Setting patient expectations at the outset is essential. The message has to start in the surgeon's office," Steed explained. "It's important to give patients a sense of security that it's now safe to go home."

The focus of the Southlake team on expediting recovery contributed to Alice Showers, 73, leaving hospital on Sunday morning after having her knee replacement surgery on a Thursday. "I didn't have any pain. I was walking with a walker the first morning," Showers said.

A week after discharge, Showers came back to have her knee assessed and then completed a six-week, physiotherapy-led out-patient class at the hospital. "I'm walking about 40 minutes now. Everything is coming along well. It's been an extremely positive experience," she said.

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