1. THE IMPACT OF PREOPERATIVE PATIENT EDUCATION ON LENGTH OF STAY FOLLOWING PRIMARY TOTAL HIP REPLACEMENT ZOE LITTLE RAGHBIR KHAKHA RICHARD SLACK DEPARTMENT OF TRAUMA AND ORTHOPAEDICS QUEEN ELIZABETH THE QUEEN MOTHER HOSPITAL, MARGATE, KENT

2. BACKGROUND  WHAT IS ENHANCED RECOVERY?  4 ELEMENTS  PREOPERATIVE PREPARATION  REDUCING PHYSICAL STRESS  STRUCTURED PERI/POSTOPERATIVE MANAGEMENT  EARLY MOBILISATION

3. AIM  TO EVALUATE WHETHER PREOPERATIVE PATIENT EDUCATION REDUCES LENGTH OF STAY FOLLOWING PRIMARY TOTAL HIP REPLACEMENT (THR)

4. METHODS  2 COHORTS OF CONSECUTIVE PATIENTS  PRIMARY THR BY SINGLE CONSULTANT  ANAESTHESIA SURGICAL TECHNIQUE CARE PATHWAY } STANDARDISED

5. COHORTS CONTROL GROUP INTERVENTION GROUP TIME FRAME APRIL - NOVEMBER 2010 APRIL - DECEMBER 2011 NUMBER OF PATIENTS 45 GENDER30F : 15M29F : 16M MEAN AGE69.9 (36-92)63.8 (31-85)

6. JOINT SCHOOL  SINGLE SMALL GROUP SESSION  MULTIDISCIPLINARY EDUCATION  PHYSIOTHERAPY  OCCUPATIONAL THERAPY  NURSING  “ WHAT TO EXPECT ”

7.  MODE NIGHTS IN HOSPITAL 3 FROM 5  76 % STAYED 1 - 3 NIGHTS  NIGHTS IN HOSPITAL REDUCED BY 2.09 /PATIENT  DIFFERENCE IN DISTRIBUTION: SIGNIFICANT - P <0.0001 (MANN-WHITNEY U TEST) RESULTS

8. POTENTIAL FINANCIAL BENEFITS  2.09 NIGHTS SAVED PER PATIENT ( £ 500-700)  120 EXTRA NIGHTS POTENTIALLY AVAILABLE PA  40 ADDITIONAL THR PER ANNUM  £ 6000 EACH ON TARIFF  £ 240K ADDITIONAL INCOME PER YEAR

9. CONCLUSION  EDUCATION SIGNIFICANTLY REDUCED LENGTH OF STAY  IMPACT: IMPROVED PATIENT FLOW FINANCIAL BENEFITS  LIKELY IMPROVED PATIENT EXPERIENCE  PSYCHOLOGICAL PREPARATION  MANAGEMENT OF EXPECTATIONS

10. SPECIAL THANKS TO...  PAT JOHNSON, WARD MANAGER, QUEX WARD  JANET ROBSON, ORTHOPAEDIC SECRETARY

11. QUESTIONS AND DISCUSSION

12. LIMITATIONS  COHORT STUDY - NOT RANDOMISED CONTROLLED TRIAL  DIFFERENCE IN MEAN AGE BETWEEN GROUPS  ALSO NEED TO CONSIDER BASELINE MOBILITY, ASA …  NO DATA ON PATIENT FEEDBACK