Ms Rebecca Cannell1
1THS-N, Launceston, Australia
Challenges for timely elective hip or knee arthroplasty (HKA) within Tasmania can be summarised into the following areas: length of time to be reviewed by an Orthopaedic Surgeon; time between being listed for, and having surgery; and average length of stay (LOS) in hospital.
Assessing patients pre-operatively through a suite of tools can provide clinicians with critical information for predicting LOS and discharge destination including the need for inpatient rehabilitation. There is currently no accepted tool within the Launceston General Hospital to indicate this need.
Occupational Therapy and Physiotherapy are trialling a number of assessment tools (Risk Predictor Assessment Tool, Timed Up and Go, Post-operative Delirium Screen, health outcome measure EQ-5L-5D, and The Oxford Hip/Knee Scale) to predict LOS and potential need for inpatient rehabilitation. Data is being collected pre and post-operatively to establish reliability and sensitivity of the chosen tools administered in pre-admission assessment unit (POAU).
From January 2017 and to August 2017, 296 patients have attended POAU, with 208 of those receiving surgery. Using complete data sets, a unique way of communicating summaries of these tools was developed, with patients classified into one of three categories; green, orange or red. Of 53 patients predicted “green”, 50 met that prediction (94.3% accuracy). For “orange” of 125 patients, 98 met that prediction (78.4% accuracy). Within “red”, of 37 patients, 14 patients met that criteria (37.8% accuracy). Low numbers of patients predicted for rehabilitation show the need for a larger sample size to further establish which of the tool/s can enhance our understanding of this population.
Strong communication of predictions has resulted in a unique way of prediction data dissemination, a common language between clinicians and a shift in HKA patients’ care. These changes have been positively received by the LGH and there is wide interest in allied health’s ongoing work.
Rebecca is a senior occupational therapist working in THS-N, with a strong background in inpatient rehabilitation and stroke care. Rebecca has more recently been involved in the multi-disciplinary teams working in the pre-operative assessment unit and acute surgical wards.