Innovative Ideas Register

Occupational Therapy Pre-assessment for Elective Hip and Knee Replacements

Development of the Initiative

In February 2002, a proposal for a new occupational therapy pre-assessment service was drafted due to problems being experienced with service delivery to elective hip and knee replacement patients. These were:

• reduced length of hospital stay (now only 3–5 days)
• patient discharge falling on weekends when reduced occupational therapy service was available
• short timeframe for completion of inpatient service (ADL training, equipment provision, home visits)
• patient’s difficulty in retaining information and contributing to planning for discharge due to effects of anaesthesia and medication post-surgery
• problems with equipment provision and safe installation of this in patients’ homes
• an increase in patient anxiety over early discharge. Patients often felt they needed more time.

Implementation of the Initiative

In May 2002, a 6-week pilot study was completed by the orthopaedic occupational therapists at Wellington Hospital to assess 20 patients booked for elective hip and knee replacement surgery in their homes prior to admission to hospital.

The purpose of these visits was to:

• provide occupational therapy information, advice and equipment
• reduce the inpatient contact time once the patient was admitted to hospital
• assist the patient to prepare for discharge home.

Results

The outcomes of the pilot project were extremely positive for both patients and the orthopaedic service. These were:

• increased patient involvement and responsibility for planning hospital discharge
• reduced patient anxiety over early discharge as they felt better prepared with their equipment and support previously arranged
• reduction of inpatient occupational therapy workload as patients required minimal follow-up once admitted
• amount of equipment provided was less, the equipment was installed safely and demonstrated by a therapist
• general impact on the ward and its staff was positive, with patients able to concentrate on recovery and mobilization rather than planning for discharge.

As a result of the feedback from the pilot, all services involved were strongly in favour of making the service permanent. It has now been in operation for over a year and continues to be successful.

Further reviews of the service have increased it to include Kenepuru Hospital and we have a reciprocal agreement with Hutt Hospital which means that all patients living in the wider Wellington region having hip and knee replacement surgery at Capital Coast DHB are offered this pre-assessment service.

This change from inpatient care to community care has allowed us to provide improved service delivery and better patient care.

Primary Contact

Sue Becker
Occupational Therapist
Therapies Service
Wellington Hospital
Capital & Coast DHB
Private Bag 7902
WELLINGTON SOUTH

Tel. (04) 385 5999 ext. 6827
email: sue.becker@ccdhb.org.nz