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Tony Smith

Can all patients benefit from the Rapid Recovery Programme?
The majority of patients who come in for elective joint replacement surgery are fit and healthy and obviously we bring them to a pre-operative assessment clinic to make sure that there are no underlying problems that we need to treat before surgery. There are a number of patients, a small number, who have underlying medical conditions, we try and control those as best as we can before surgery and some of these patients are not able to achieve the goals that we’re setting in terms of discharge date.  However, what we do see is that these patients still go home a lot earlier and mobilise a lot more rapidly than they would have done say even 3 or 4 years ago. So the benefits are seen all the way across the spectrum.

We started off focusing on knee replacement patients, we’ve now moved onto hip replacements and I’ve also been utilising this programme for our revision joint replacements. Now obviously those patients tend to have more extensive surgery and as a result they take a little bit longer to get going, but there’s no doubt that the benefits are seen all the way across the spectrum of treatment.


How would you respond to people with concerns?
We’ve been going for over a year now and I think the data that we’ve collected is robust and there’s no doubt that whilst one of the headline benefits of the Rapid Recovery Programme is decreased length of stay and this appeals very much to the hospital management in terms of efficiency savings. My primary concern has always been the patient experience and the patient outcomes and having collected data post-operatively of the patients who’ve been through the Rapid Recovery Programme their outcome scores are significantly higher, at least in the early stages following surgery than I was seeing before the Rapid Recovery Programme.  So I’m able now to support what we’re doing with the results that we’ve seen.  Some patients are a little bit apprehensive about mobilising very quickly, certainly on the day of surgery but I think with encouragement and support and the excellent multidisciplinary team we’ve got in place, I have yet to see patient who hasn’t been delighted when they first get out of bed within a couple of hours of surgery.


What successes have you seen from the programme?
Successes that we’ve seen have been many fold.  Obviously the programme was designed to be patient focused and to be achieving good results for the patients and I think there’s no doubt we’re now able to support this with evidence with our outcomes data.  The success of the programme with regards to patient outcomes is quite remarkable.

I think the additional benefits that I probably wasn’t expecting when we started out is the way that it’s drawn the team together, because it’s been important from day one to have a multidisciplinary approach and everyone has put a considerable amount of work into this and everyone’s now being rewarded with the results that we are seeing.  It’s trickling all the way across the department, which is very rewarding and it’s certainly an additional benefit that I didn’t anticipate, but is quite noticeable.


What benefits has it brought to your Hospital?
There’s no doubt that the profile locally and nationally of our hospital has been increased considerably by this programme. It started off as a small local project and now we’ve been ‘up and going’ for some time, we have results to show that we’ve got a number of very happy patients and GPs.  Our profile has risen quite considerably and we’re now been asked to help other hospitals in the vicinity and indeed across the whole of Wales to develop a programme at other sites.  So the profile of the hospital has risen enormously in a positive way.

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Interview with Tony Smith, Consultant Orthopaedic Surgeon