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Video Interview

 

"..it’s definitely built our reputation
and improved financially the situation of the Trust."


David Houlihan-Burne

Consultant Orthopaedic Surgeon


David Houlihan-Burne

The Rapid Recovery Programme was implemented because of the pre-existing random processes within the NHS for hip and knee replacements.  When I started at Hillingdon in 2005, patients went through a different programme, a different pathway, depending on which Consultant was treating them.  There was no structure behind their treatment and consequently their outcomes were acceptable, but not excellent, and the lengths of stay were unnecessarily long, so they were in hospital for 8 or 9 days, when really they should have been ready to go home at 4 or 5 days.


So having seen the system working well in America, we introduced it into this country, and really it’s all about patient satisfaction and the patient outcomes, and removing the anxiety and the stress from the surgery, which by consequence reduces the pain, and it means that they stay in hospital for less time.


To the Trust it has brought financial benefits, there’s no doubt about it, we’ve just heard the financial figures from our general manager.  But its brought reputation as well; we’ve been in the national press now and we have an increasing referral base from other regions other than our own, month on month, so in that respect it’s definitely built our reputation and improved financially the situation of the Trust.


Well it’s very important, we don’t think of ourselves as just another DGH, we want to be the best DGH in the country, you’ve probably heard that already today.  We’re not a teaching hospital, but we do strive to be the best DG Hospital.  We’re not here to accept acceptable outcomes, we want to strive for excellence; you treat every patient like they’re one of your family, you want the best treatment for them whichever Trust they go to and that’s what we aim to strive for here.


To me, in my own practice, I just have a higher throughput of patients, which means as a surgeon, I like operating, I operate more.  My patients are much, much happier than they used to be.  They know what to expect from the surgery, the surgery goes to plan and they come back and see me in the clinic and the results are good.  They’re happy and they’ve just had a good experience in hospital, whereas previously patients weren’t particularly happy.   They didn’t know what was going on, it was stressful, not only for them, but for their families, and the families are now very heavily involved as well, and they are encouraged to participate in the programme with the patients themselves.  It’s patient centred, so for a surgeon to see their patients happy, that’s the ultimate goal.


We have seen successes in terms of a dramatic reduction in the length of stay of our patients.  We have good data to back that up; what we don’t have is data to show a reduction in our complication rates such as infection rates, and blood clots and thrombo-embolic disease.  There’s no doubt that early mobilisation of patients, which is one of the fundamental parts of the Rapid Recovery Programme, reduces blood clot rates and therefore allows patients to go home quicker, therefore reducing infection rates.  We will have the data to show that when we have the numbers, but that’s very much an anecdotal experience.


For those sorts of outcomes you probably need a few thousand patients.  We’re nearly up to one thousand patients on the programme so far, but we suffer as with a lot of Trusts in an ability to capture accurate data, so the next phase of the study is to create a very robust database so that we can collect lots of data points for many things, and in particular, for the functional outcomes of the patients as well as their satisfaction. 


Well we’re moving very much towards a much more robust consent procedures in the NHS, and consenting of patients prior to surgery is not great at the moment.  And the Joint Replacement School and the Rapid Recovery Programme really cements a great foundation for the patient understanding the operation and its unfortunate occasional complications, and they need to understand that in order to put themselves through that; they need to be fully informed of the procedure they’re going to have and the Joint Replacement School allows you to do that.  And what I’m going to start doing very soon is a competency based assessment by physiotherapists and nurses in order to take consent from the patients for those procedures. So that’s where we’re moving next, but also with the data collection that we discussed earlier.


Fantastic, it’s a no-brainer if I can use the term, none of what we’re doing is rocket science, it’s all common-sense; its about really what should have been done for years and years and years, the problem is we’re all too disparate as a group of individuals within a Trust and we should be working together within the Trust: within our own speciality, between specialities and between Trusts, and we can learn off each other.  And if we do this and we change simple things, as simple as patient education, we can see some dramatic results in terms of satisfaction and length of stay, so it’s very satisfying having visiting groups from around the country - we’re on our fourth visit now, we must have had eight or nine groups from different Trusts, and they all go away hugely enthused with the programme and I hope they adapt it and take it on.


The main challenges are getting different specialities to work closer together and in particular getting anaesthetists and surgeons to talk; for surgeons to understand pain control and for anaesthetists to understand what surgeons want in terms of mobilising patients post-operatively.  If you can get that relationship sorted out, you can get the best pain relief for your patient whilst allowing them to mobilise early following their surgery.


The other challenges were persuading the managerial side of the Trust, in ways of a business case, to pull out physiotherapists and occupational therapists to use their time to educate the patients in the Joint Replacement School.


The whole programme encompasses and develops teamwork.  Right from the hospital porter who brings the patient to theatre all the way through to the recovery nurse who recovers the patient before they go back to the ward.  Every single person within that chain is involved. I can’t do my operation unless the porter brings the patient to theatre.


So its really encouraged teamwork and all of a sudden everyone feels part of that patient’s journey, everyone feels responsible for that patient and everyone wants to work hard to make sure that that patient’s experience is the best it can be.


I’m a great believer in you treat every patient like they’re your brother, sister, mother or close family relative.  If you do that you can never go wrong.  And what you want for your relative is the best care, in the best environment, with the best outcome, and I really believe strongly that Rapid Recovery provides this.


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