New England Baptist Hospital has pioneered an Accelerated Rehabilitation Program for patients having a joint replacement (arthroplasty) of the hip. It all began with a study of 590 hip replacement patients that demonstrated promoting early mobility can decrease length of stay, influence discharge disposition and decrease the likelihood of postoperative complications and hospital readmission.
Total hip arthroplasty (THA) and associated care has experienced successful evolution over the past forty years. In recent years, THA protocols have been influenced by improvements in surgical technique, changes to implant design, inception of multimodal pain procedures, and accelerated rehabilitation programs.
In 2010, NEBH introduced an accelerated THA protocol, which utilized extensive patient education prior to surgery, advances in pain control during surgery, and the proven benefits of having the patient move sooner after surgery. The surgical team sought to examine the effect of the accelerated THA protocol on length of stay, discharge disposition, and hospital readmissions and complications. Additionally, it was hoped that successful implementation of the THA protocol may in turn influence the development of multidisciplinary accelerated total knee and spine protocols.
A retrospective review of 590 patients who underwent THA at NEBH between January 1 and April 30, 2011 was performed. 190 patients were in the accelerated THA protocol group and began rehabilitation on the day of surgery, and 400 patients were in the standard protocol group and began rehabilitation the day after surgery. The length of stay, discharge disposition, and hospital readmission/complication rate were assessed.
Patients who received the accelerated rehabilitation left the hospital 1.32 days earlier than those who underwent standard protocol and they experienced fewer complications after surgery. 96% of accelerated rehabilitation patients were able to go directly home rather than to a rehabilitation facility, which compared to 62% of those who went through the standard protocol. Results of the study concluded that an accelerated rehabilitation protocol can decrease length of stay, influence discharge disposition and decrease the likelihood of postoperative complications and hospital readmission.
Prior to surgery, patients meet with a nurse or physical therapist and are given information on the accelerated THA protocol. They are encouraged to attend pre-operative educational classes, which prepare patients on what to expect during and after surgery.
After surgery, patients are discharged from the post anesthesia care unit (PACU) to their room via stretcher. Once in their room, the patient walks from the stretcher to their bed with a walker or crutches. Most patients begin physical therapy and are able to walk down the hall the same day they had surgery. All hospital staff including nurses, physical therapists, occupational therapists and case managers participate on postoperative care and assist the patient on their accelerated road to recovery.
NEBH is currently in the process of conducting a research grant with Harvard Pilgrim Healthcare, which is studying accelerated total knee patients.