Abstract
Aim To review 6 months of early discharge with a dedicated ‘Accelerated Discharge Team’ (A.T.T.) at our institution.
Patients and Methods The team consisted of four nurses and three physiotherapists. Patients undergoing hip or knee arthroplasty were assessed pre-operatively and post-operatively for admission to the care of the A.T.T. against fixed criteria. Patients were visited at home on the day of discharge and every day until released from the care of the team. 333 patients underwent lower limb arthroplasty during the study period of which 305 (91.6%) were admitted to the A.T.T.
Results The mean length of stay for primary knee replacements was 3.30 days. 73% (95% C.I. 64%–81%) of patients undergoing total knee arthroplasty went home by 3 days and 93% (95% C.I. 87%–97%) by 4 days. Results for hip arthroplasty were similar. Of the 305 patients, 12 (4%) were readmitted to hospital within 6 weeks of discharge. Almost 90% of patients responded to a satisfaction survey. 94.2 % of those responding indicated that they would use the A.T.T. scheme again.
Discussion In the year before implementing the A.T.T. the mean stay for primary hip and knee replacements was over 9 days. We reduced this to less than 3.5 days for over 90% of our patients during the study period. The total cost of the scheme was just under £100 000 for the 6 month period. We estimate that 2000 bed days were saved during the same period. This is cost effective on these terms alone. As well as transferring 12 elective orthopaedic beds to a different department we were able to perform an estimated 75 extra lower limb arthroplasty operations in the 6 month period.
Correspondence should be addressed to Mr T Wilton, c/o BOA, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
