Dr Benedict Williams, Dr Sarah Dunn, Mr Nirad Joshi, Dr Anil Singh, Mr Adrian Simons
The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
Introduction: Recently there has been a shift towards shoulder arthroplasty being performed as a day-case procedure. A new day-case care pathway for shoulder arthroplasty was introduced at Cannock Chase Hospital - an elective orthopaedic centre, part of The Royal Wolverhampton NHS Trust. A single surgeon and anaesthetist team piloted the pathway. Selection criteria were set and patient information was provided at the surgical outpatient and pre-assessment clinic.
Methods: A retrospective service evaluation audit focusing on patient satisfaction was conducted. Notes were reviewed followed by a telephone survey of 15 patients who had followed the pathway over a 12-month period. The follow-up proforma focused on patient satisfaction, pain control, overall experience and whether the patient would recommend day-case care to others.
Results: Results showed no major complications and no readmissions. 14/15 patients received Total Intravenous Anaesthetic, Interscalene and Suprascapular Nerve blocks. 100% had a 0 out of 10 pain score in recovery. Average pain score within 24hrs was 3.2/10 and after 24hrs 3.2/10. Pain was managed by simple analgesics and prescribed Oramorph was often not required. One patient had significant pain during the first night when their block wore off. No patients reported nausea. All patients were extremely satisfied with having a day-case procedure and would recommend it to others.
Discussion: Following successful implementation of the pathway in the pilot group, as demonstrated by high patient satisfaction scores, the day case shoulder arthroplasty pathway will now be rolled out within the Trust.