Transforming Orthopaedic Postoperative Care
Medway NHS Foundation Trust’s Surgical Medical Acute Response Team (known as SMART) in partnership with the trust’s trauma team has recently introduced a novel care pathway for patients who present in the emergency department (ED) with lower leg fractures.
Previously, these patients were admitted under the care of the trauma team and managed as an inpatient until swelling had reduced and a time to operate became available. This meant patients were kept in hospital for up to eight days prior to surgery.
Now, once a patient’s condition is stable, they can be discharged and remotely monitored by SMART using Current Health’s technology until a theatre slot for surgical repair is confirmed.
By incorporating Current Health’s remote patient monitoring (RPM) platform into the new pathway, preoperative care can be delivered safely and effectively at home by allowing SMART to:
- Monitor vital signs continuously with hospital-level accuracy
- Manage lower limb edema via video consultations
- Monitor for thrombotic complications or skin breakdown
- Educate and support the patient about remote monitoring and self-care
- Supervise the preoperative planning process
How the Virtual Care Pathway Works in Practice:
The first stage of this pathway starts in the ED where the fracture is stabilised, heparin is prescribed to prevent deep vein thrombosis (DVT) and the case is referred to the surgical repair waiting list. Following this, the patient is referred to the SMART service where a nurse can initiate remote care using the Current Health platform based on an initial assessment.
DAYS TWO – FIVE
On a daily basis, virtual visits with the patient are conducted by the SMART nurse, using the telehealth technology built into Current Health’s platform. Patients’ continuous vital sign data, captured by Current Health’s sensor, are also reviewed to evaluate patients for signs of thrombotic complications or infection.
Swelling is expected to subside within 5-7 days post-injury at which point, the SMART and trauma teams can finalise a time to undertake surgery.
One day prior to surgery, a home visit by a SMART nurse is arranged to complete preoperative blood tests and a final evaluation of the fracture in preparation for admission.
DAYS SEVEN AND EIGHT
Following surgery, the aim is to discharge patients home on the same day and continue remote patient monitoring postoperatively for a further 24 hours.
The Impact of Virtual Care: 90% Decrease in Bed Days and High Patient Satisfaction Ratings
With the implementation of the remote care pathway, only 1 day of inpatient care is needed in comparison to 10 days (8 days for preoperative management and 2 days for postoperative care). This saves the hospital a total of 9 bed days, allowing for beds to be utilised by patients requiring acute hospital care.
Patients who have followed the trauma pathway to date have rated the overall experience very highly as it has enabled them to prepare for and recover from surgery in the comfort of their own home.
Check out our case study to discover how Medway has expanded its virtual care service to support the management of COPD patients at home.