Pre-op education for TKR and THR: What do patients think about going home sooner after surgery?

Enhanced recovery pathways shorten the length of time that patients stay in hospital. This has obvious economic benefits for the health system, and many clinical benefits for the patient, but what do patients actually think about accelerated discharge?

Research published last year in the journal Health Expectations looked at patients’ experiences of accelerated discharge after hip replacement to see how acceptable they thought a shorter length of stay was (Click here for the article). Using patient interviews to collect data the researchers compared the experiences of patients in a traditional unit with a unit that utilised a rapid recovery regime.

The results showed that patients were not primarily concerned with length of stay and nearly all of the patients stated they were happy with their care. Patients were more concerned with how attentive staff were and all indicated one or more areas of criticism. Themes for complaints centred around feeling overlooked, feeling “in the dark”, and feeling uninformed or anxious about aspects of surgery and peri-operative management.

In regard to the length of stay, patients generally did not question discharge time, although those who were treated in the traditional unit could not countenance a more rapid discharge. Patients in the accelerated discharge unit had concerns about the consequences of early discharge for them or their family. This was particularly in regard to how they would manage pain, and the need for more support at home.

So what can we learn from this research when implementing enhanced recovery?

Firstly, it is apparent pre-operative education is very important. Patient’s want to know what is happening and why. This was found in both the accelerated pathway and the traditional pathway. Being “kept in the dark” increases anxiety for patients, making early mobilisation and accelerated recovery for surgery more difficult. Therefore, when we are implementing enhanced recovery pathways it is crucial the pre-operative education processes prepare patients so that they are empowered to take control of their recovery and rehab. For this to happen, patients need to be informed about what’s going on and why.

Secondly, preparing patients so that they will feel able to cope at home whilst in hospital is crucial. Examples of this are getting patients to self-medicate and control their pain independently, as well as encouraging them to be complete all occupational therapy and physiotherapy goals. Steps such as these help to promote a “wellness” model of care rather than an “illness” model. This provides the patients with confidence that they will be able to cope once they go home, especially in regard to managing their pain and mobilising. Lastly, supporting patients once they are home is important. A post-discharge phone call, a detailed information booklet to take home, and an early clinic check-up are all important milestones which help to ensure patients do not feel isolated once discharged.

What are your thoughts on the article? Do you routinely collect patient feedback on your pathway? What methods do you use to do this? And are your findings different to the research paper? Please use the comments section or get in touch with us directly.