Post discharge review clinic
As SWLEOC is a standalone hub for elective orthopaedic surgery for the four acute South West London Trusts, it does not readmit patients if they have a complication post-surgery. Patients were historically advised to contact their GP or attend A&E, resulting in high readmission rates, with SWLEOC being an outlier in this metric. Through validation, it was determined many of those non-medical re-admissions could have been avoided, if the patient was reviewed by one of the surgical or medical team, rather than the GP or A&E.
Pathway
A new pathway was developed and signed off by the Clinical Governance committee as a safe and robust pathway for patients following discharge. Patients contacted PACU or the ward (dependent on where they were discharged from). Following a discussion with a senior nurse or physiotherapist and depending on the concern/complication, the patient is triaged into the most appropriate pathway. This may be advice over the phone, or the patient may be asked to send photos of their wound (if it is a wound-related problem).
If deemed necessary and as a safety net, patients may be booked into a face-to-face clinic review in the purpose-built post discharge review clinic room. They will be reviewed by a senior nurse and depending on their assessment may request that the patient be assessed by the Intensivist or the on-call surgeon. An agreement has been established with the host trust Radiology Department to fast track a doppler scan for patients with a query DVT in a ringfenced slot, significantly reducing the wait time for the scan and can be started on the treatment they need. SWLEOC has its own ringfenced X-ray unit so that patients requiring an X-ray receive this without delay.
Complications
Surgical concerns or complications are now managed by the SWLEOC team ensuring continuity of care, a robust safety net, expert assessment and prompt escalation. Patients with concerns are offered advice and re-assurance by the expert team and can continue their recovery journey with confidence. Patients with a complication are started on the most appropriate treatment plan as soon as possible, with treatment by the right clinician at the right time.
Re-admission rates have seen an improving trend being better than the peer and national median, with patient concerns and complications managed by the specialist surgical team rather than the GP or A&E.