- Page navigation anchor for RE: Same-day discharge following hip and knee arthroplasty will require physician leadership, system redesign and adoption of evidence-based best practicesRE: Same-day discharge following hip and knee arthroplasty will require physician leadership, system redesign and adoption of evidence-based best practices
We share Bodrogi and colleagues vision that same-day discharge will become common following total hip and knee joint arthroplasty. Three key ingredients for success include physician leadership, system redesign (integration) and adoption of best peri-operative practices.
First, physician support will be critical in leading the design, implementation and evaluation of same-day discharge programs. Some physicians, including primary care will need to evolve traditional patterns of referral, triaging, assessing and caring for same-day arthroplasty patients. Regional central patient intake, nurse practitioner-led assessment clinics, anesthesia-led pre-operative optimization, and virtual care in monitoring patients discharged home are examples of needed care evolution.
Secondly, system redesign in Ontario will be aided by the new Ontario Health Teams (OHTs). OHTs will ultimately be responsible for providing a continuum of care. The integration of primary and specialty orthopedic care with outpatient rehabilitation centres and Home and Community Care will evolve in the context of same-day discharge. The integrated OHT will need to plan for pre-operative optimization, and post-operative home visits including physical therapy. This need could be minimized by patient education including exercise, started well in advance of surgery (prehabilitation) by adoption of best practices.
Third, Enhanced Recovery after Surgery (ERAS) is an “evidence-based multidiscipl...
Show MoreCompeting Interests: None declared.
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