Hip Clinic > Accelerated Discharge

What is accelerated discharge?

Research has shown the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their hospital stay will be. The NHS is very keen to reduce length of stay, and considers a low length of stay as an indication of high quality service [A BETTER JOURNEY FOR PATIENTS AND A BETTER DEAL FOR THE NHS FULFILLING THE POTENTIAL Published on behalf of the Enhanced Recovery Partnership by NHS Improvement http://www.improvement.nhs.uk/documents/er_better_journey.pdf] .

There is considerable evidence that using a "standardized bundle of care" improves efficiency and patient safety. This starts with optimisation of your health by your GP before surgery [NHS Choices Web Site Enhanced recovery http://www.nhs.uk/conditions/enhanced-recovery/Pages/Introduction.aspx] .

Application of the research findings and principles to joint replacement [An orthopaedic enhanced recovery pathway Tom Wainwright, Robert Middleton Current Anaesthesia & Critical Care (2010) 1–7 http://www.enhancedrecoveryblog.com/wp-content/uploads/2009/10/An-Orthopaedic-Enhanced-Recovery-Pathway-In-Press-corrected-proof.pdf] is focused at key points in the process:

Preoperative Assessment

Thorough pre-operative intervention to optimise health and medical condition.
Management of patient expectation through pre-operative education and counselling.
Organisation of discharge arrangements.

Surgical Technique

Atraumatic and minimally invasive surgical techniques.
Short surgical times.
Optimised anaesthesia - usually regional anaesthetic techniques with light sedation.
Promotion of normal tissue oxygenation and perfusion - prevention of hypoxia.

Promotion of a ‘‘wellness’’ model of post-operative care

Regular and effective analgesia with avoidance of opiates where possible.
Catheters, drains and drips are removed as soon as possible.
Rapid introduction of normal hydration and feeding.
Independence with washing, dressing and socialisation is promoted.
Early physiotherapy intervention and promotion of ambulation.
Physiotherapy twice a day by the physio team until discharge goals are achieved.

Planned Discharge

Patients are discharged home ASAP.
Criteria-based discharge protocol managed by the multidisciplinary team.
Patients have clear instructions on how to progress rehabilitation independently.

How can I enrol for accelerated discharge?

The evidence to support accelerated discharge relies upon uniform bundles of care. By standardizing the care any effect upon the outcome and patient experience can be measured with more confidence. This means that accelerated discharge will work best for patients with "standard" needs.

Some aspects of the prescribed care many not be suitable for patients with other medical conditions or special needs. Although it is possible to use parts of the "bundle of care" this is less likely to achieve the same effects.

Patients in good health, keen to participate and with good home support are ideal for this method of care. Please ask about accelerated discharge (also known as ERAS) when you are seen for pre-operative assessment.

My Role in Enhanced Recovery - Accelerated Discharge

Self help ideas from the NHS

Can I opt out of accelerated discharge?

Accelerated discharge is not for everybody, and is not always successful. If your personality does not respond well to persistent encouragements to "hurry along", however well meaning, then accelerated discharge may not be for you.

As long as every patient approaches recovery with the intent to do their best, then we must accept that some will progress faster than others. Publicly exclaimed dissatisfaction [Ludden Problems after gynaecological ERAS http://www.nhs.uk/Pages/comments.aspx?contentId=36788&AreaId=2] with accelerated discharge arises when patients feel the enouragement has crossed the line to bullying - just say no!

With any surgical procedue there is a small risk of complications, it is very important that these are identified before discharge if possible. If the planned accelerated discharge does not seem to be progressing this is a warning to check for problems.