WORKPLAN#4 - HOSPITAL SERVICES COORDINATED CARE
Developing an enhanced recovery program for TJR
Chief Investigators: Nicholas Taylor, Peter Choong, Trisha Peel.
Associate Investigators: Michael Barrington, Stefan Lohmander.
The McKeon Review highlighted that practice inefficiencies and preventable surgical complications are major cost drivers in the healthcare system. The impact of enhanced recovery programs, and multidisciplinary care pathways on preventable surgical complications, on patient satisfaction and on hospital and societal costs has not been established, limiting the wider adoption of such pathways. This Workplan will address these important knowledge gaps, applying mixed methods research to develop and refine a multimodal enhanced recovery program; forming the basis for a concerted effort to improve the delivery of TJR services nationally and internationally.
A pilot cohort study to inform this Workplan undertaken at SVHM, examining the impact of day of mobilisation on length of stay and complications. Overall, a third of patients who mobilised within the first 24 hours following TJR had a significantly shorter mean length of stay compared to patients mobilised after 24 hours. 23% experienced one or more post-operative complications. And there were significantly fewer post-operative complications in the early mobilisation group. Overall, early mobilisation was associated with a 45% reduction in post-operative complications. Our NHMRC (Application 1057736 and 502021) supported work to date has demonstrated post-operative complications occur in 24.3% of patients after TJR and were a major driver of costs.
Workplan #4 will develop a multidisciplinary care bundle to optimise patient care following TJR using mixed methods in a staged approach to test and refine the bundle. This pragmatic research program will be rolled out in five major interlinked avenues of investigation spanning multimodal enhanced recovery, clinical and economic impact, randomised trials, tailor approaches, modelled health economic analysis, RCT and multimodal stakeholder feedback sessions.
We have received private funding to undertake a large part of this study. In addition to examining the impact on length of stay and cost-effectiveness, this portion of research is critical in informing the final stages, examining the impact of the enhanced recovery program on post-operative complications. This will happen through networks established by the research team and will be enriched by data from early stage trials. This research will be conducted in the ‘real-world’ comparing the clinical and cost-effectiveness of an enhanced recovery program to the Medical Research Council Framework.
Expected Outcomes and significance:
Workplan#4 will provide new knowledge about the clinical and health economic benefits of and lead to the development of evidence-based guidelines for patient care following TJR. In addition, enhanced recovery programs may be associated with significant reductions in healthcare costs through decreased length of stay and reduced post-operative complications.