A Case of Improved Value for Patients
Hip and knee arthroplasty is a frequently done and highly successful surgical intervention. The surgical procedure is able to relieve pain, restore function and improve quality of life in patients with advanced hip/knee osteoarthritis. Total hip replacement has been defined “The operation of the century” (Lancet, 2007). Worldwide, more than 1 million total hip replacements are done each year.
Indications for hip or knee replacement were initially largely restricted to either elderly and infirm people or individuals with functional limitations associated with other comorbidities. However, today, an unacceptable compromise in quality of life constitutes a valid indication for hip or knee replacement.
In this scenario, Humanitas Ortho Center is a high performance center with more than 3.000 hip and knee arthroplasty performed in 2019.
Given the numbers of patients in need for this kind of surgery, our waiting lists reached 12 months in 2017. Thus, we were in need to find a way to free assets and increase the number of surgeries, maintaining the level of clinical excellence and patient experience.
Rapid Recovery program is a combination of the optimisation of clinical protocols and organisational processes, pursuing the reduction in surgical stress and optimizing the preoperative medical condition, with the aim of reducing convalescence time and accelerate functional recovery.
Historically the patients were hospitalised for weeks after arthroplasty, with a long bed-rest time.
In 2016, our Hospital stay was 14 days; in 2017, it decreased to 9 days.
In 2018 a multiprofessional team (surgeons, anaesthesiologists, hospitalists, physiotherapists, physiatrists, scrub, pain and ward nurse and asset management), organized as an integrated practice unit (IPU) and redesigned the complete cycle of care starting from international benchmark and patients’ needs.
Using a design thinking approach, Humanitas is reaching value for patients relying on People (IPU together with patients and caregivers), Processes (review of the clinical pathway) and KPI.
The model we used is based on:
– Identification of the critical issues and therefore of our goals using KPIs related to the pathway
– Interviews to our patients asking about their experience on the current pathway in order to add another point of view on critical issues
– Involvement of all the actors in order to write a new Integrated Care Protocol based on international guidelines and a new patient journey
– Creation of a set of KPIs, an action plan, a business case. When the board and the CEO approve the business case, all the actions are prototyped, tested, implemented and measured to verify the actual impact
– Communicating of results to the team
As a conclusion, we obtained the result to free assets for 300 more patient per year, achieving better patient satisfaction, lower complication rates, and a reduction in the transfusion rates, with a decrease in re-admissions.
Next step is analysing the future challenges for Rapid Recovery, such as the possibility of moving towards outpatient surgery, introducing prehabilitation in the pathway.