“’Day zero standing’ as it’s often referred to by physiotherapy professionals, isn’t new to the NHS but has been gradually adopted as standard practice over the last 4 to 5 years,” explains Physiotherapy Clinical Lead, Susan Hawkins. “There is strong evidence to support earlier rehabilitation to help people over the psychological hurdle of seeing themselves as unwell or of worrying that they ‘shouldn’t move in case they disrupt something’, which can quickly lead to loss of confidence and slow down recovery. We need those coming in for planned joint replacements to think about the procedure as being more like a ‘tyre change’ and not something that needs to leave them debilitated for a long period.”
The fast-track approach to recovery and rehabilitation is suitable for all patients particularly those who enjoy an active life-style and want to quickly return to regular activities, work and exercise. The key to success is as much about preparation for surgery as the intensive physiotherapy input afterward.
“By working with suitable patients following their hip and knee surgery we were able to show the dramatic effect of starting rehabilitation on the day of surgery”
Susan continues, “We’ve adapted our pre-assessment so that patients are fully aware of what to expect and are mentally prepared to be on their feet quickly after their operation. There is still a degree of trepidation but we aim to get as many people as possible moving as soon as possible after their surgery, even if it is just to sit up on the edge of the bed – to decrease any worries.
“The joy of day zero standing (or sitting) is that it helps them to see how strong their new joint is, how safe the stitches and drips are, and how good for them it is to get their joints moving and maintaining their range of movement and strength. There will be some patients who are not ready for a day zero stand, usually for medical or anaesthetic reasons, but we anticipate that this number will be small, especially because of the benefits we’ve shown for patients who do a day zero stand.”
Introduction of the enhanced recovery programme has been brought about by the physiotherapy team at St Michael’s Hospital themselves, who committed a good deal of personal time to testing it with a small group of patients. They were supported in this by their anaesthetic, nursing and surgical colleagues.
“By working with suitable patients following their hip and knee surgery we were able to show the dramatic effect of starting rehabilitation on the day of surgery. It’s been possible to reduce the length of time in hospital for these patients by around 1 day, so that they are then ready to go home 2 or 3 days after surgery. In exceptional cases it has even been possible for some patients to go home the next day after surgery.”
The trial meant the team was able to collect data to back up the benefits for patients, as well as show increased efficiency and savings too. This has now been supported by investment to expand the programme. The team has been increased from 2.5 to 6 physiotherapists, extending their working day into the evening so they now cover from 7.30am to 8pm and they are also providing more therapy input at weekends.
“Our aim will be to see patients two to three times each day, getting them on their feet and doing everyday tasks such as walking to the loo, dressing and washing themselves. Before now those kinds of things didn’t begin until the day after surgery or longer,” says physiotherapist, Amy Tildesley. “Working later in the day will now mean we’ll be able to start rehab with patients who’ve had their operations during the afternoon as well.”
Patients on the enhanced recovery programmed will receive follow-up telephone calls from the physiotherapy team two days and two weeks after going home to check that all is going as planned and they are provided with a contact point if they have any concerns.
“It has also meant changes in practice for our nursing, anaesthetic and medical colleagues,” adds Amy, “and we’re really grateful for the way they have supported us to get this new service up and running. It will mean that we’ll be able to support the planned increase in patients being treated at St Michael’s Hospital and the high quality of care for which we are recognised.”
Patients who want to have their surgery at St Michael’s Hospital should make sure they choose Royal Cornwall Hospitals Trust on ‘Choose and Book’ when their GP makes a referral and then, provided they are medically suitable, they can then choose St Michael’s for their operation.