The Vancouver General Hospital joint replacement rapid recovery program: Optimizing outcomes through focused pathways

Summary 

Developing focused, streamlined programs that improve quality of life, speed recovery and reduce costs for people requiring hip and knee arthroplasty is a Canadian imperative given the long waiting lists for surgery and the prevalence and impact of joint disease.

The Vancouver General Hospital interdisciplinary orthopaedic team noted that patients who experienced delays in recovery did so as a result of preventable problems. The Vancouver Model for Accountable Care (VMAC) was created to guide the redesign of the joint replacement program to facilitate prevention, detection and best management of these predictable problems. The new program expedites recovery by anticipating and minimizing risks for delayed recovery and actively engaging patients in preparing for surgery and rehabilitation. The program includes a pre-surgical screening tool to identify potential risk factors that can be addressed while the patient is awaiting surgery, a pre-operative education program, interdisciplinary assessment tools, pre-printed physician’s orders and a revised, streamlined, problem-based clinical path that spans the continuum of care. The Rapid Recovery program helped reduce the length of stay (LOS) by one full day for people following hip and knee arthroplasty.

Keywords: Hip arthroplasty, Knee arthroplasty, Pre-operative screening, Patient education, Integrated care pathways