Keywords: Rehabilitation;Innovation;Flexibility Purpose: To demonstrate that our Trust can run a cost efficient elective orthopaedic service delivering a high volume of in-patient and day-case operations, optimising resources to assist with clearing the backlog of patients due to COVID-19 pandemic. The aim was to complete 100 arthroplasties in seven days. The project was entitled BONES week. Methods: Overall planning utilised a multidisciplinary approach. From a rehabilitation perspective the pathway was divided into three stages. For each stage, national guidelines were adhered to. Pre-operatively: All patients had a therapy telephone pre-assessment to identify equipment and care needs and clarify patient expectations. Equipment was in situ prior to admission and referrals for care commenced reducing post-operative interventions and minimising delays in discharge. Post operatively: Day 0 physiotherapy assessments, multiple physiotherapy inputs including exercise classes, regular ice treatments were undertaken. Simplification of documentation to increase efficiency. Full seven day extended hours physiotherapy service implemented to enhance treatments capabilities. On site stock of orthotic and ADL equipment to decrease delivery time. Follow up: Trust affiliated community therapy team with acute therapy-led rapid handover provided next day treatments. To enable this service to be provided, therapy staffing was tripled in line with increased demand. The staff was sourced from redeployment and locum agencies. Results: 135 arthroplasties and 85 day cases completed in 7 days. Improved patient care and experience, reduced length of stay, better utilisation of theatre space and resources. The average length of stay decreased by 1.5 days and three day 0 discharges completed. Conclusion(s): With sufficient planning and staffing we have demonstrated that a cost efficient high turnover elective orthopaedic service is possible without compromising patient care. The expectation of 100 arthoplasties was exceeded. A decreased length of stay was demonstrated as achievable with the right resources in place. Suggestions for the future include early access to TCI list for pre-operative assessment, late shift physiotherapy to allow early initiation of therapy input and reduce movement of patients between wards. Improvements in timing of check X-rays to prevent unnecessary delays in therapy. The introduction of an online pre-operative education video to Trust website. Impact: Significant changes to elective re-start planning due to this project. COVID secure pre-operative therapy education and assessment implemented. Therapy staffing structure has been adapted within the scope of current resources and post operatively protocols changed to reflect new practices introduced during BONES project. Business case submitted, supported by BONES project data, to permanently increase therapy staffing to a full seven day service at project level. Funding acknowledgements: Work was not funded.
Reflection and development of rehabilitation following a perfect week in elective orthopaedic surgery