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Undertaking your
first Day Case
THR: Our Story
Hiren Divecha
Consultant Trauma & Orthopaedic Surgeon
Length of stay after THR
Why Day Case THR?
Patient preference
Safety?
Risks?
Outcomes??
Health-economics
Potential saving of £900 per patient
How did we achieve it?
TEAM WORK!
Enhanced recovery nurses
Physios
Pharmacists
Ward sister/ staff nurses
Anaesthetist
Theatre scrub staff
Surgeons – Tim Board and myself
Create your TEAM
Develop your
Pathway/ Protocol
Conferences / BADS
See it in action
Plan your first case
Just Do It!!!
Just Done It!!Critique/
multi-source feedback
Tweak your Pathway
Do it again !!Monitor
progress/ outcomes
Think of service
development needs
Where are we up to ?
Pilot phase / “Proof of concept”
First patient 28th Nov 2018
Since then we have had 18 patients
No readmissions
No complications
Waiting list = 12 patients
14
3
10
2
4
6
8
10
12
14
16
Day 0 Day 1 Day 2
What’s next for us?
Continue to refine our pathway
Auditing postop analgesia usage
Maybe broaden our patient selection
Are we missing on potential candidates by being too strict?
Business plan needed
Team expansion / development
Investment required
The WWL Day Case THR Experience: A patient’s perspective !
Pre-operative feelings
Relieved
I didn’t want to spend a night in hospital
Empowered
Due to my age and good level of fitness I felt that I was able to contribute to being a day case
Excited
This was new
Nervous
How would I cope at home?
Could I get into bed?
Up the stairs?
How would my partner look after me?
On the day feelings
Nerves
Obviously!
Speed
From admission (7am) I was constantly having some part of the process performed
I didn’t have time to think about the operation itself
Relief
After the operation
Also the feeling that there was constant care around me
Support but no pressure
I was encouraged to walk and get out of bed
Did not feel forced to do this
Asked how I felt about going home
Door to door in 12 hours!
Post operative feelings
Recovery
Started immediately
I didn’t feel like a patient at home
I was equipped with the medication needed to manage the pain
Support
I felt the support was available if needed
I would have liked a call or follow up appointment closer than 12 weeks just to check pains and that recovery was going in the right direction
More aids needed at home – toilet riser, sock aid, grabber etc
“I would recommend day case to everybody that has care
at home and able to walk immediately after the
operation, especially in younger patients as a hip
replacement is seen as an ‘old person’ procedure” – Sean
Craven 2019
