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Consultant Orthopaedic Surgeon

 

 

"...clinical evidence shows
that length of stay is being reduced."


Mr Vikas Vedi
Consultant Orthopaedic Surgeon


Mr Vikas Vedi

I’m one of the Consultant Orthopaedic Surgeons, I specialise in hip and knee surgery.  I guess my practice is about 50/50 hip replacement and knee replacement, also I manage soft tissue conditions around the hip and knee as well.  All of my elective work is hip, knee and some foot and ankle surgery, and we’re all part of the trauma rota, so we spend a little bit of time managing the acute injuries and broken bones as well.


The Rapid Recovery Protocol I think allows a more streamlined, patient centred approach to management of joint replacements and give the patients far greater education.  So for me, it enabled me to achieve a better care of the patients who were undergoing joint replacement by consolidating under one title really, the whole care process.


Clinical data shows that the length of stay has been reduced, but more importantly I feel, patient satisfaction is very high.  Patients now understand far more about what’s happening to them, why they are having a joint replacement, what that really means on a practical level, learning more about their stay in hospital, learning more about the rehabilitation and knowing what to expect.  All of that has enabled them to have realistic expectations, and not be shocked by the fact that they may not be staying in hospital as long as they might have expected, by knowing friends or other relatives who have actually had a joint replacement and stayed in for much, much longer.


From our point of view as a surgeon and a clinician, it gives us a great deal of satisfaction to see patients doing well.  The whole team around us is far, far more motivated; the care is standardised so everyone knows what they are doing, and that makes the job much, much easier for myself.


Once people are on board then because of the standardised care pathways, the care for the patient is far more streamlined, and as a result of that my job is easier; everything from giving information to the patient and discussing their diagnosis and treatment options in the outpatient department, through to managing the patient in the operating theatre and performing the procedure.  Because we use a standardised protocol now, my whole operating team knows what each surgeon does, which makes the procedure run smoother.


I try to measure success in a number of ways.  Firstly clinical evidence shows that length of stay is being reduced; Patient satisfaction: all our audits have shown that patient satisfaction is very high.  Certainly last winter the reduced inpatient stay was partly responsible for lack of a winter bed crisis in our unit at Hillingdon.  Lately all of my patients are so happy that they have actually been informed and involved in the decision making and been given information to allow them to prepare for the procedure.


One particular patient springs to mind is a young lady, which is unusual for joint replacement, but a lady who was suffering severely with rheumatoid arthritis who had had one hip done already by another surgeon at another hospital, and came to see me for her second hip replacement, and literally called the experience chalk and cheese.  Purely because her stay at the previous hospital was disorganised, she was in hospital prior to the surgery to have blood tests and ECGs, had to come back on a couple of occasions.


Her experience with us here: the treatment was all streamlined, she was able to attend once for all her investigations and get the information about the Joint School, and the information she was given at the Joint School, she therefore was, despite having had a hip replacement on the other side, far better prepared and stayed in hospital for two and a half days.  She was very, very happy and walked out of here, and came back at six weeks walking unaided.


Clinical practice these days has to be on the basis of evidence, it’s evidence based medicine that we now practice.  Gone are the days when a surgeon or a clinician of any sort could do what they wanted because that’s what they believed was the right thing.


Market forces are different; clinical practice of medicine is different now, and we have to prove that what we are doing has an evidence base for it.  The Rapid Recovery Protocol in principal is a wonderful concept, but it means nothing unless there is clinical evidence to prove that there is some benefit to the patient, and patients are happy with it.


We have proven that with our clinical audits, both looking at clinical measures such as length of stay, range of motion, and also looking at patient satisfaction.  All of that evidence suggests that there has been a reduction in our length of stays, patients highly satisfied, and our level of complication has not increased.


In our hospital, all patients, whether they be primary joint replacements or revision procedures, young and old, with any form of other medical co-morbidities, are all entered into the Rapid Recovery Protocol.


I think the ultimate goal would be that it’s taken up by the NHS, throughout the whole of the NHS.  We’ve had contact with various NHS executive organisations and various health commissioning type organisations who have been asking us and inviting us to come and learn about new innovations, yet we were proud enough that we wrote to our Chief Executive to tell him that people should actually come and learn from us, and we’re very grateful that other Trusts are now visiting us to learn about the Rapid Recovery Protocols that we have implemented, and hopefully learn from our experience, and I hope that this sort of practice will become the base practice for all joint replacements in the NHS.


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