Same-day hip surgery pilot frees hospital beds

“In a hospital, bed space is often a challenge,” said Kayla MacRae, a physiotherapist with Queen Elizabeth’s Hospital’s Unit 1. “If you have hip or knee replacement surgery scheduled and there’s no free bed to admit you in, your surgery could be cancelled. And that’s the last thing anyone wants. Having surgery cancelled can be very stressful for a patient.” 

Like everywhere else in the country, the Queen Elizabeth Hospital has regular capacity issues. 

“Of course, that means we’re always looking for ways to improve our efficiency, while focusing on good patient care,” said Owen Brown, a process improvement analyst with Health PEI. 

Those ideas came together in the form of a pilot this spring that’s showing real promise. 

When someone comes into the QEH for a hip replacement, their typical stay at the hospital is one to two days. 

“One of our surgeons, Dr. Paul Kelly, has been working the past few years to send some patients home on the same day,” said Brown. “It’s not a wild idea. Many people can safely be discharged from hip replacement in a day. It’s a fairly common practice off-Island.” 

“The problem was, some of our procedures were making things unnecessarily complicated,” explained MacRae. “After having an anterior hip replacement surgery and spending some time being monitored in the recovery room, we would move the patient across the hospital to admit them to Unit 1. The physiotherapy team would assess and treat the patient. If deemed ready, the patient would then be discharged home.” 

It meant a lot of unnecessary movement across the hospital. The entire care team sat down to discuss how they could make things better.  

“It was great to have everyone working together,” said Brown. “We had Dr. Kelly, pharmacy, anesthesia, nursing, and physio, all discussing how we could make this better for the patient.” 

“The solution ended up being wonderfully simple,” said MacRae. “Dr. Kelly carefully screens for candidate patients. After the surgery, the patient goes onto the recovery room. We decided to skip the step of transporting the patient across the hospital and admitting them to a hospital bed. As soon as the anesthesia has worn off, I’m called down from Unit 1. I do my physiotherapy assessment with the patient right in the recovery room area. It skips a big step and makes the whole process much easier for the patient.” 

As a bonus, MacRae has more direct contact with the rest of the team who performed the surgery. 

“If there are issues I need to know about, they’re all right there in Day Surgery,” she said. “It’s an ideal set-up, honestly.” 

Reducing the stay in hospital also frees up much-needed bed space. 

“The early results from the pilot are extremely promising,” said Brown. “If we were to reduce the average stay of hip replacement patients by just one day, we’d decrease the number of bed days at the QEH by about 212 days (about seven months).” 

And when every open bed counts, that’s a big difference. 

Now that the pilot period has ended, the team is continuing to screen for patients who would benefit from day-surgery. It turns out about a third of patients are eligible, with many more being able to go home after just one day. This pilot was for direct anterior approach hip replacement. The group is looking to expand this same-day project to both lateral hip replacement and knee replacement. 

“It’s worked out so much better than I hoped,” said MacRae. “Our work is easier. The patient can recover more comfortably at home. We free up bed space. It’s that rare win-win-win in health care.”