[oramar]

We are starting a Fast Track program for knee and hip replacements. It starts with intensive pre op outpatient teaching for the candidate. It will include surgical day, two post of days and discharge day. The patients will apparently have a coach who will go through the program with them and be willing to spend at least at week at home after discharge. The patient is to be up and dressed and in Physical Theapy next morning after surgery. Anyone else doing this? How is it going?

[Marie_LPN]

We are actually in the works of starting something similar. Right now we're just in a bunch of meetings, nothing else yet.

[SueIP]

One of our surgeons does a 4 day fast track and I have to say that out of all the surgeons his Pt's do the best and have very little pain if any. He has standard post op orders which work really well with majority of the pt's.

[meownsmile]

We use standard post op orders. All our orthos are up the evening of surgery for 30 minutes unless written to remain in bed. All are discharged after the fourth night or on day3 post op and follow up with either outpatient physical therapy or a short stay in transitional care for continued physical therapy. All do very well with proper teaching.

[P_RN]

meown are yours admitted as inpatient or is this a new "observation" status?

[NRSKarenRN]

Since Medicare and insurance companies changed reimbursement, this fast track program is exactly what we are seeing in Philly area.
Baring complications, by day 2-3 moving to
a. Rehab if both hips/knees done for 3-4 days
b. Significant comorbidities: SNF for a week
c. Relatively healthy come straight to me, er, homecare 2-3 days post op.
A & B come to homecare post discharge till ready for stairs and improved ROM/endurance tolerate outpt Rehab.

My agency provides next day PT including Saturdays at branch with "big name" ortho group operating at local hospital.

Less complications overall reported.

[meownsmile]

Our post ops are admitted through same day surgery and go to inpatient at post op. John Doe arrives to same day surgery in AM,, goes to inpaitent ortho post op, next day counted as day 1, day 2 usually dressing change and drains removed, and patient is weaned off any PCA to oral pain meds. Day 3-4 most go to TCU or home with PT depending on how well the patient is doing, but most do great.

Actually we have one ortho doc that has standing orders to get patient up the night of surgery for 30 min, and if they arent up you have his wrath to deal with. Unless he writes not to or there are blood pressure problems he wants his patients UP, no excuses.

[P_RN]

That seems to be what we were doing 5 years ago. With one exception. (doc very slow and old fashioned, but now retired)

1 week before surg to hsp for labs, meet w/ anesthesia, teaching by CNS, practice 1 session w/ PT.

Same day surg, admit to floor, up that nite, cpm if ordered,

next 6am epidural out, up w/ PT bid, advance diet, po pain med, next day PT bid and home 3rd day PO.

Problems maybe 1 more day-very rare. Older or sicker pts maybe to rehab for progression.

In '77 when I began there were 80 ortho beds. When I retired it was down to 30 beds -about half and half ortho and med/surg.

[meownsmile]

That has pretty much been our routine on ortho since i started in 93. I didnt know other places werent doing that.

[ladywiththelamp]

We have started a "Rapid Recovery" program for total joint pts. that meet certain criteria, in which they are home the next afternoon. Ours is an "aggressive" postop recovery unit since the hospital hired a Nurse Practitioner that manages the total joint replacement program in cooperation with the dozen ortho docs in town. Otherwise, the total joints that are back by 2 PM, are up out of bed with therapy the afternoon of surgery (except for certain things, like legs still numb from spinal) up for supper, and all tubes pulled & dressing changed by 7 AM the next day. Discharge is day two, or three, for slow pokes. Pain control is a prominent issue, and this has been "tweaked" with great results.
I was outraged when this program was instituted (and it spilled over into fractured hip care as well), but we have not had any pneumonia, clots, or infections since. Okay, one pneumonia, on a fractured hip patient.
It's been amazing.