Northumbria was experiencing long waiting lists for elective orthopaedic procedures, including hip and knee replacements. There was also a growing incidence of post operative pain and surgical site infection. Northumbria was also struggling to effectively manage equal access to services for both its urban and rural populations.
Northumbria designed an integrated model of care for all elective orthopaedic cases. Development of strong community services and shared planning and patient management enabled a stratification of patients. High risk patients or those with particularly complex procedures were managed in the specialist emergency hospital. Those patients with low risk were able to receive their knee and hip joint replacements as short stay or even as a day case at general hospitals.
Low risk patients were reviewed by a multidisciplinary team and physio and nutritional programmes developed as part of their pre-operative care. Pre-operative patient education was provided and was an important part of the successful care pathway pre- and post-operatively.
Arriving as a well prepared and informed, patients were admitted and had their operation using local anaesthetic. Patients had the option of surgery under a regional block anaesthetic technique which provided superb post operative pain control and allowed very early rehabilitation.
All patients had access to Northumbria’s well established enhanced recovery programme – which included early mobilisation with physiotherapy and nursing assistance as fundamental to recovery and complication rates. Patients were up walking just a few hours later and discharged the same day.
Higher need patients were referred to the Surgical Enhanced Recovery Unit, with a high nurse to patient ratio. Northumbria has also developed a dedicated bone and joint infection unit that is one of only a few in the UK delivering multidisciplinary team management of complex bone and joint infection cases, which has been essential to delivering the best possible outcomes.
- Now performs 2,300 hip and knee operations each year and is one of the biggest units for shoulder and elbow surgery in the UK. Even shoulder and elbow replacement surgery is now being done as day case surgery for some patients;
- As a result of the integrated planning approach and learning, Northumbria’s Spine Surgery Service is able to perform complex spine surgery procedures at a general hospital;
- Is consistently rated in the top 5 across the UK for hip fracture care;
- Is a leader in multicentre research trials in almost every area of orthopaedic surgery;
- Training has won multiple awards, and are recognised as some of UK’s most innovative including rated top in UK by junior doctors training in trauma and orthopaedics in General Medical Council’s 2016 national training survey;
- Has a higher net promoter score than Apple;
- Focuses on continual improvement, and has reduced peri-prosthetic joint infection and surgical site infection from over 5% in 2008 to less than 0.5% in 6 years;
- Successfully maintains the shortest length of stay for hip replacements patients in the UK;
- Has successfully reduced mortality and morbidity; and
- Has 98% patient satisfaction, high staff satisfaction and one of the highest staff retention rates in the UK.
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