SERVICE IMPROVEMENT PROJECT - Trialling an enhanced recovery pathway

Reduced demands on the service due to Covid-19, allowed the orthopaedic physiotherapy team at the Great North Children's Hospital to trial an enhanced recovery pathway for reducing the length of stay in adolescent idiopathic spine correction.

The spinal team at the Great North Children’s Hospital typically perform 2 adolescent idiopathic scoliosis (AIS) corrections per week.  The average length of stay for these patients was 7 days, which was one of the highest in the UK.   They were the only centre in the UK not providing routine post-operative physiotherapy with mobility being nurse-led starting day 3 post-op.

During Covid-19 demands on the orthopaedic physiotherapy team were reduced and temporary staff in post provided the opportunity to trial an MDT enhanced recovery pathway.  The aim of the pathway was to reduce the length of stay and to improve the patient experience by providing twice daily physiotherapy from day 1 post-op to discharge, along with other nursing and medical changes in pre- and post-op management.  A physiotherapist was also present at the pre-op assessment and provided a follow up phone call 1-2 weeks post-discharge.

The trial was implemented over a 10 week period June to August 2020 and included 11 AIS patients.  Data was recorded by the physiotherapist that provided the session to analyse therapist time, mobility achieved, pain control, removal of lines and catheters, and any barriers to achieving mobility goals.  At the end of the trial period length of stay had reduced to an average of 5 days.  Patients were safe for discharge by day 4, delay in discharge was caused by not being able to access routine X-ray on a weekend.   

The results were regularly reviewed to enable any changes to the pathway to be made using the PDSA cycle.  As a result of this we were able to address issues such as planning X-rays to be done on a Friday to allow discharge over a weekend if patients completed stairs assessment, and changes to analgesia to reduce nausea.  

The reduction in length of stay equated to potential savings of £62,400-£93,600 per year.  Patients completed a satisfaction questionnaire during their follow up phone call.  All feedback was positive regarding early mobilisation and the patient experience from pre-op assessment to discharge.

We hope to secure funding to increase physiotherapy resources to further develop the pathway and to continue to provide high quality input based on this service improvement project.

For further information on this project please contact Karen Makinson on

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