We have developed the ‘Chichester and Worthing Enhanced Recovery Programme’ – known as CWERP – for planned hip and knee replacements, which is helping patients to feel well enough to go home faster.
In the past, patients receiving routine hip and knee surgery normally spent about seven days in hospital.
They often suffered side effects following surgery, including feeling sick, which delayed their ability to mobilise as well as their overall speed of recovery.
Since CWERP has been introduced, the average stay for hip and knee patients has fallen from seven days to an average of 2-3 days. Many patients are able to go home the day after their operation. We have also successfully, safely achieved day zero discharge, with patients able to go home the same day as their operation.
The ‘enhanced recovery’ approach introduces several key changes:
Joint School
A two-hour session involving The Lead CWERP Practitioner, anaesthetists, physiotherapists, occupational therapists, dieticians, and specialist nurses. The patient is better informed, meaning they are more relaxed and confident to begin rehab quickly.
Anaesthetics
Most patients no longer receive a general anaesthetic, but instead have a spinal injection, along with sedation. Local anaesthetics are then injected into the joint, along with a strong combination of painkillers. This means the patient is conscious and alert immediately after surgery – and can even be conscious during surgery if they wish! – and is therefore able to recover faster, and feel better.
Rehabilitation
Because patients are feeling so much better after surgery, they can begin to move far more quickly. Many are already beginning to mobilise on the day of surgery, and it is not uncommon for patients to be able to stand within three hours.
Telephone follow-up
Patients are contacted by a member of the team two days after leaving. This ensures that any patient concerns can be addressed quickly, and potential problems are picked up at an early stage.