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Day Case Shoulder Arthroplasty - How To Develop A Pathway

India Cox, Nicola Doody, Stephen Hannah
University Hospital Wishaw, Wishaw, United Kingdom


Introduction: Although currently total shoulder arthroplasty (TSA) is not included in the British Association of Day Surgery (BADS) Directory of Procedures, the procedure fulfils the surgical criteria for same day discharge. In line with national guidance, and given the current pressure on arthroplasty waiting lists, our centre has set out to establish a pathway to safely perform day-case TSA.

Methods: We reviewed the literature, local audit and BADS guidance to determine the feasibility of undertaking TSA as a day-case. Using established quality improvement methodologies, and with reference to existing protocols from other centres, we developed and piloted a local pathway.

Results: After review of the literature and BADS benchmarks for hip and knee arthroplasty, we set the aim of 30% of all TSA in our centre being performed as day-case by January 2024. Process mapping has allowed us to identify and collaborate with stakeholders in each step of the patient’s perioperative journey, and by utilising the Model for Improvement Framework and iterative PDSA cycles we have developed enablers for each stage. These include robust patient exclusion criteria, early electronic pre-assessment, patient education and risk management interventions, surgical/anaesthetic guidelines and appropriate follow-up protocols. To date 4 patients have undergone TSA as a day-case in our centre with good early outcomes.

Conclusion: We have designed a local pathway for day-case TSA based on exclusion criteria rather than default inpatient TSA. We have successfully piloted this pathway and would propose the inclusion of TSA in the BADS Directory of Procedures.