innovations to increase quality and decrease length of stay in foot and ankle surgery
TRANSCRIPT
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INNOVATIONS TO INCREASE QUALITY AND DECREASE LENGTH OF STAY IN FOOT & ANKLE
SURGERY
Adam Ajis
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Introduction
Modern NHS - Increase focus on quality
Every trust cares about quality
Beware Mid-Staffs
What is quality?
Clinical effectiveness, safety, patient experience
Patient centred
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Introduction
Reducing LOS is linked to quality Improved patient experience Faster recovery & return to normal activity Improved safety Improved outcomes Increases capacity, efficiency & value £200 BPT uplift day case bunion surgery
Enhanced recovery programme Successfully applied to hip, knee & # NoF
Must be applied to all stages in patient pathway
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Change in mindset
Day case surgery should be the ‘norm’
Safety in mind
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GP Referral
An all systems review of patient
Medical conditions optimised
Get the patient involved early
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1st OP Appt
Reinforce shared decision making
Agree a date for surgery
Discuss discharge, recovery & rehab
Start Integrated Care Pathway
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1st OP Appt
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Pre-op Assessment
Anaesthetic involvement
Risks identified – action plans made
Social circumstances taken into account – action plans made
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Pre-op Assessment
Meet physiotherapists
Learn techniques of rehab
Have a range of patient specific options
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Admission
Optimise hydration
CHO loading
Minimise starvation
Reinforce plan for early mobilisation – ward physio
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Intra-operative Normothermia
Avoid opiates/N2O
Multimodal analgesia
Popliteal/ankle blocks
Minimally invasive techniques
Avoid drains & catheters
Use mini c-arm
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Post-operative
Eat & drink asap
Analgesia
Mobilise asap Consider 7 day ward physio
Nurse led discharge
Integrated care pathway driven
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Follow up
24 hr emergency contact number
Follow up telephone call
Emergency fast track OPD
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Monitoring
PROMS MOXFQ SF-12
Patient satisfaction surveys
Risk management – near miss reporting
Care pathway usage
Reasons why day case failed
Regular meetings
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Conclusion
Change in mindset
Streamlined effective pathways
Pt ready for surgery & us ready for pt
Best possible care during surgery
Post discharge support
Audit & monitoring