Tailor-made discharge plans mean it's all in day's work for Sulis Hospital physio lead Joanna Gotley

Joanna Gotley, physiotherapy lead at Sulis Hospital – which is situated just south of Bath – has spoken with pride about a new clinical pathway that means patients can be discharged much more quickly after having hip and knee joint replacement surgery.

Joanna said: ‘Safety is always our number one priority and by pre-assessing patients, carefully planning follow-ups and rehabilitation, we are able to offer same day surgical procedures which are proven to allow for a much quicker recovery.

‘Each patient is assessed individually, and, for most, this procedure will be the best and quickest method to allow a quicker recovery with each patient having a bespoke and tailored discharge plan put in place.'

The hospital’s enhanced recovery programme or enhanced recovery after surgery initiative aim to help every patient recover from surgery more quickly and are based on guidelines issued by the National Institute for Health and Care Excellence (NICE).

We’re incredibly proud of our joined-up approach, including our unique rehabilitation and psychological support programmes, which are a key part of the pathway [Joanna Gotley]

Traditionally, patients receiving knee or hip joint replacement surgery spent three days in hospital to recover but now many go home on the day of surgery. Sulis Hospital said that 44 day case patients had received joint replacement surgery in a three-month period, with an average of 0.96 days spent in hospital.

Joanna added: ‘Having worked with Sulis Hospital for over 10 years, it’s great to see ongoing advancements in surgical procedures benefiting all of our patients. We use the best practices to reduce risk whilst ensuring the patients are physically able and medically stable.

‘We’re incredibly proud of our joined-up approach, including our unique rehabilitation and psychological support programmes, which are a key part of the pathway.’

Patients who recover at home are encouraged to take ownership of their recovery, helping to increase their independence. Day case surgical procedures also help to reduce the backlog of patients waiting for surgery – of whom there are said to be seven million people in England, a record high.

Benefits of same-day surgery

Day surgery has many benefits: patients are back home in their own surroundings on the same day, helping them return to their daily routines more quickly. Patients who have same-day surgical procedures suffer fewer complications, enjoy a faster recovery and are less at risk of developing deep vein thrombosis.

Former patient Sylvia Smith said: ‘I can only describe my hip surgery as miraculous. It was amazing to be able to recover at home after leaving the hospital on the same day as my surgery. There is no doubt that the quicker you move after your operation, the faster you recover. There was no pain or swelling – you wouldn't know I had had hip surgery.'

Sylvia added: ‘I do believe that there's more to recovery than just physical health; recovery depends a lot on a positive mental attitude and taking ownership. Almost three months have passed since my hip surgery, and I am fully recovered.’

Patients are 'key members of the team'

Consultant Sam Heaton described patients as a ‘key member of the team’ who are a ‘part of this journey, not a passenger’. ‘Modern anaesthetics for your joint replacement involve a low dose spinal anaesthetic and a powerful local anaesthetic which both combines to numb the surgical area and give much better post-op pain relief than a general anaesthetic. Combining this with early physio mobilisation is crucial in early fast recovery and reducing complications.’

Restoring the joy of movement is what joint replacement surgery is all about, so the traditional practice of bed rest for most of the day of surgery now seems contrary to this goal [James Berstock]

Orthopaedic surgeon James Berstock said: ‘Developing the same-day arthroplasty programme at Sulis has challenged us to up our game surgically, anaesthetically and in the delivery of nursing care and intensive physiotherapy. As a surgeon, it is so rewarding to see my patients walking pain-free and feeling great just a few hours after a hip or knee replacement.'

He added: 'Restoring the joy of movement is what joint replacement surgery is all about, so the traditional practice of bed rest for most of the day of surgery now seems contrary to this goal.’

Sulis Hospital Bath was called Circle Bath before Royal United Hospitals (RUH) Bath NHS Trust acquired it. It's the UK's first fully operational private hospital in which all the shares are owned by an NHS trust. The acquisition increased capacity for both NHS and private patients and cut waiting times for 4,933 patients in the past 12 months.

To find out more about Sulis Hospital, visit: https://www.sulishospital.com