Introduction
The Golden Jubilee University National Hospital (GJUNH) in Clydebank, Glasgow is an Orthopaedic National treatment centre undertaking approximately 3000 elective primary hip and knee arthroplasty procedures annually- forecasted to increase to 6000 in the coming years.
In 2020 a day case arthroplasty pathway was introduced to GJUNH alongside our traditional inpatient ERAS pathway.
Methods
Patients were identified in outpatient clinics and highlighted as suitable for same day discharge. Patients then proceeded through pre-operative assessment where their suitability for same day discharge was assessed. Patients were then admitted on the discharge day of surgery pathway where they followed a standardised protocol.
Developments over the past 4 years include- a relaxation of inclusion/exclusion criteria, development of patient information booklet, video and promotional posters, a mandatory day 0 tick box on all consultant clinic forms, staff education and engagement, and an extended physiotherapy service until 8pm.
Results
232 patients have commenced on the pathway since 2020, 132 of those in 2024.
47.4% of patients were successfully discharged on the day of surgery and 87% by POD 1. The most common reason patients were unable to be discharged on the day of surgery in 2024 was hypotension.
Conclusions
In conclusion a day case pathway is feasible within a national treatment centre.
However to meet national targets further improvement is required to ensure processes are in place to enable all suitable day surgery candidates to commence on the pathway.
Authors
Rachel Mainland
Golden Jubilee National Hospital, Glasgow, United Kingdom