REDESIGN OF AN ARTHROPLASTY SERVICE FOR ORTHOPAEDIC NURSE PRACTITIONERS USING A US SURGEON’S ASSISTANT MODEL: DOES IT WORK IN THE U.K.?

Abstract

Introduction. A redesign of a joint replacement service to increase throughput and reduce length of stay despite a reduction in junior doctors hours, recognised that Orthopaedic Nurse Practitioners (ONP) based on the US Surgeons’ +

+ Assistant model would play a pivotal role in managing patient flow efficiently.

Redesigning the Service. The ONP has input at every step of the patient journey. In Outpatient Clinic they see follow-up and selected new patients, commencing the informed consent process if appropriate. They run an information program to patients awaiting surgery, are involved in Pre-Admission clinic, assist in theatre and oversee post-operative care monitoring progress, ensuring earliest possible safe discharge and prescribing as necessary. Continual Audit, Research and development to improve the service are part of the role.

Outcomes. The impact of the introduction of the role after 4 years together with service redesign has been:

1. An increase in the number of new referrals seen in OPD by 50% from 8 to 12 per clinic.

2. An increase in the volume of hip & knee replacements from 490 in 2003 to 834 in 2007.

3. Increased theatre efficiency with routinely 2 joints per session.

4. A reduction in length of stay from mean of 10.75 days in 2003 to 6.89 days in 2007.

5. Continuous monitoring of post-operative infections with current cumulative rate of 0.71%.

6. Improved patient satisfaction as measured by patient feedback sessions.

Conclusion. Based on the US Surgeons’ Assistant model, with involvement at every step of the patient journey, ONPs have been the most important single element in the redesign of the joint replacement service to meet a massive increase in demand. Further ONPs are being recruited to fill the gap envisaged by a reduction in junior doctors hours as a result of the European Working Time Directive.