Arthroplasty Class Innovation: "Taking efficiency steps together"

Purpose

As part of the team objectives for 2017 we wanted to look at a redesign of the Post-Operative Arthroplasty class to improve time efficiency of qualified members of staff and reduce the overall cost of treatment of this patient group. The aim was to do this without compromise of patient safety and patient satisfaction.

Through a literature search we found multiple literature reviews that compared supervised to non-supervised exercise programs. They revealed that supervised exercise programs by physiotherapists yielded similar patient outcomes to home based exercise programs for post operative care of TKR/THR surgery.

However it did not show or demonstrate overall patient satisfaction with the care provided post rehabilitation. We therefore surmised that to lower costs yet maintain patient satisfaction was to utilise non-qualified members of staff for post-arthroplasty rehabilitation

 

The Number of people with Trendelenberg reduced
from 16.6% to 10.8%.



Using a mid-band 6/5 vs a mid-band 4 pay scale, cost analysis revealed savings
in the TKR group of £76.61 per patient and the THR group of £57.80 per patient.
Patient satisfaction remained 100% positive
pre and post service change.

Approach

We performed a pre-service change audit of objective outcome measures, patient satisfaction, patient safety and a cost analysis of post-operative physiotherapy care in 2017 for 42 patients. Under the previous structure patients were seen in a class setting by qualified members of staff alongside an exercises session with therapy assistants.
We analysed this data and considered how our service could utilise band 4 members of staff to facilitate post-operative care.

The new structure was designed to have an initial assessment with a qualified physiotherapist. They then transferred to a band 4 member of staff for 1:1 sessions until achieving a set of criteria, established by the qualified therapist, to move onto a circuit based group exercise session with therapy assistants if appropriate.


Outcome measures were used to ensure patient safety, patient satisfaction and optimal outcome from surgery. There was also senior support available for more complex patients.
The outcome measure for 99 patients in 2018 were subsequently compared with the outcomes pre- service redesign.

Outcomes

We assessed 141 across 2017-2018 with total hip replacements (THR) and total knee replacements (TKR). Following the implementation of the new structure, there was no significant difference in the average number of sessions attended in the arthroplasty class.

The number of 1:1 sessions patients received doubled post implementation. Oxford score improved by 3 points on discharge post service change. In the TKR group the average range of movement was maintained (pre-service change 1.93 - 107.1 degrees and post service change 0.8 - 109.9 degrees).

The Number of people with Trendelenberg reduced from 16.6% to 10.8%. Using a mid-band 6/5 vs a mid-band 4 pay scale, cost analysis revealed savings in the TKR group of £76.61 per patient and the THR group of £57.80 per patient.

Patient satisfaction remained 100% positive pre and post service change. Patient satisfaction, patient safety and outcome from arthroplasty surgery were not affected by the change from being treated by qualified to non-qualified members of staff. Patients received more overall sessions through the new service structure and this achieved an overall cost benefit for the Trafford General Hospital Musculoskeletal Physiotherapy department.

Implications

  • Physiotherapists utilised more efficiently; reduced waiting list, increased income for department
  • Increased 1:1 post-operative input for TKR/THR patients

Funding acknowledgements

N/A. 

Additional notes

This work was presented at Physiotherapy UK 2019