Health Column – Louise Benson: reducing the length of stay

We have come a very long way since the 1960s when Sir John Charnley introduced the first successful total hip replacement to the world at the site. Back then, patients could be with us for up to 30 days but by 2010, this was down to four days with enhanced recovery care plans in place to help people recover more quickly following surgery.

This has pretty much remained unchanged ever since Wrightington, like many units across the UK and worldwide, now regularly achieve safe, early discharge in one or even fewer days following the operation.

Our challenge at Wrightington, being a nationally recognised Surgical Hub, was to bring our overall length of stay in line with national Getting It Right First Time (GIRFT) programme, an NHS England programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting evidence to support change.

Together, orthopaedic surgeons, anaesthetists, therapy teams, nurses and non-clinical support staff looked at updating pain management protocols, outcomes were audited, previous ways of work were compared, and pathways were changed through collaborative working between teams.

We have shown from our current audit of change that reducing a patient’s time with us after their operation, is not only achievable with minimal change to the patient’s experience of their care from the moment they decide to have surgery until discharge, but, more importantly, is associated with better patient satisfaction and no increase of early complications.

Patients who were up and mobile out of their bed within hours after their surgery had a reduced length of stay of 1.9 days, compared to three days with the older protocol. Additionally, there was a reduction in patients reporting moderate or severe pain, nausea, dizziness and urinary retention.

We have received some wonderful feedback from our patients including comments that they had imagined they would be in hospital for up to four days, and that they couldn’t believe their hospital journey could be any better. One patient had surgery on a Wednesday and was home the following day and walking which they hadn’t been able to do for nine months.

This Project also won the Best Clinical Audit 2024 at our WWL Clinical Audit Awards and has been nominated for a WWL STAR award, our internal annual staff awards ceremony.Our challenge now will be to continue building on this success and looking at other surgical procedures that could also benefit from the findings of this project to achieve safer reduced lengths of stay.