Elective orthopaedic team at Raigmore Hospital in Inverness leads the way for post-operative services
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The elective orthopaedic team of Ward 3C at Inverness’s Raigmore Hospital has managed to improve patients’ surgical journeys.
It has done this through staff and patient education, and through the review and development of enhanced recovery after surgery (ERAS) services, which focuses on reducing surgical stress on the body.
ERAS has been reviewed and adapted in line with evidence-based practice, resulting in overall benefits to patient recovery and a reduction in the length of stay for orthopaedic arthroplasty patients.
Over a period of time, the average length of stay for hip surgeries at Raigmore has reduced from three days to two, and from four days to two for knee surgeries.
Discharges after one day are rising, and in the future the team hope to have a 23-hour in-patient service.
Raigmore is second in Scotland for day zero mobilisation – meaning patients are out of bed on the same day as their operation. Data from the week commencing September 12, 2022 showed that 100 per cent of patients were mobilised on day zero. In 2019, only 15 per cent of patients were mobilised on day zero. Previously mobilisation was always done by a physiotherapist, whereas now it is joined with nurse-led mobility.
Previously sixth in the ranking, Raigmore is now first in Scotland for ERAS compliance, measured by four main concepts: return to food and diet on the same day post-operation, no IV fluids, no catheterisation, and day zero mobilisation.
Jillian Schurei, senior charge nurse in Ward 3C, said: “These statistics show great results. However, the most important aspect is the feedback from patients, who say that early mobilisation helps in several ways, including pain reduction.
“While we acknowledge that sometimes there will be exceptions to these numbers, I have to commend the elective orthopaedic team who have adapted and taken all challenges in their stride to improve the overall patient experience.
"This wouldn’t have been possible without input from a multi-disciplinary team, made up of pre-op assessment, ward nursing staff, ERAS and arthroplasty nurses, physios and occupational therapists, consultants, and ongoing support from Kay MacGregor, our assistant divisional nurse manager.”
The development of ERAS has involved looking at ways of ensuring that patients’ expectations are managed prior to coming in for surgery.
Weekly presentations and discussions for pre-op patients are held on Near-Me, NHS Highland’s virtual consultation service. The team have also collaborated with community GPs and spread awareness of the ERAS programme and arthroplasty helpline, which offers an in-house review service and in turn reduces the primary care workload to free up GP appointments.
By summer 2023, the arthroplasty and ERAS nursing team are aiming to complete their prescribing and clinical examination to further improve patient care by providing a fully comprehensive nurse-led service.
Rebecca Clark, an ERAS practitioner, is presenting on digital consultations at the ERAS UK conference in Leeds on Friday, which some of the ward team will also be attending.
