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?
Sep 4, '06
by NRSKarenRN, BSN, RN
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. :wink2:
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.
Last edit by NRSKarenRN on Sep 4, '06
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.
Last edit by meownsmile on Sep 5, '06