Opportunities to optimise care and choice in joint replacement surgery using a digitally delivered, holistic PreHab pathway.

PURPOSE: To describe the implementation and evaluation of a hospital-initiated, community-based, digital prehabilitation program (My PreHab Program: MPP) for adults referred for elective joint replacement. METHODS: MPP was implemented July 2022 and comprises a personalised digital health screen that guides the provision of self-management resources. Adults (>18 years) referred and accepted, or already waitlisted, for total knee/hip replacement surgery were eligible. Individuals requiring category 1 (urgent) or emergency surgery and those without a mobile phone were excluded. Implementation and intervention outcome measures (program adoption, equity of reach, fidelity, acceptability, appropriateness, feasibility, engagement, preliminary surgical outcomes) were explored via study-specific measures and hospital records. RESULTS: Of those invited (N = 689), 77.8% participated. Participants and non-participants were similar in key demographic variables except regional invitees were more likely to participate than metropolitan (88.0% vs 75.4%, p = .002) and non-participants tended to be older (median age = 69.0 vs 64.0, p = .005). Participants reported on average four modifiable risk factors: most commonly chronic pain (79.1%), obesity (57.3%), and frailty (40.9%). Most participants (80.4%) reviewed all resources provided and reported action/intention to address issues identified (90.9%). Participants perceived MPP as acceptable (3.2/5), appropriate (3.3/5), and feasible (3.4/5). Early trends for participants progressing to surgery (n = 33) show a reduced length of stay (MPP = 4.3, baseline = 5.3 days). CONCLUSION: MPP demonstrated high adoption, fidelity, and participant engagement. It is acceptable, appropriate and feasible and has the potential to be scaled-up digitally at low-cost. Modifiable risk factors were prevalent and early indications suggest this preoperative intervention may benefit both patients and the healthcare system.

Development of a feasible and acceptable digital prehabilitation pathway to improve elective surgical outcomes.

Objectives: To codesign and assess the feasibility, acceptability, and appropriateness of a hospital-initiated, community delivered approach to health optimization (prehab) prior to planned surgery. Design: Participatory codesign combined with a prospective, observational cohort study (April-July 2022). Setting: A large metropolitan tertiary referral service with 2 participating hospitals. Participants: All people referred for orthopaedic assessment for joint replacement surgery (hip or knee) triaged as category 2 or 3. Exclusions: category 1; no mobile number. Response rate 80%. Intervention: My PreHab Program is a digitally enabled pathway that screens participants for modifiable risk factors for post-operative complications and provides tailored information to enable health optimization prior to surgery with the help of their regular doctor. Outcome measures: Acceptability, feasibility, appropriateness, and engagement with the program. Results: 36/45 (80%) registered for the program (ages 45-85 yrs.), completed the health-screening survey and had ≥1 modifiable risk factor. Eighteen responded to the consumer experience questionnaire: 11 had already seen or scheduled an appointment with their General Practitioner and 5 planned to. 10 had commenced prehab and, 7 planned to. Half indicated they were likely (n = 7) or very likely (n = 2) to recommend My PreHab Program to others. The My PreHab Program scored an average 3.4 (SD 0.78) for acceptability, 3.5 (SD 0.62) for appropriateness, and 3.6 (SD 0.61) for feasibility, out of a score of 5. Conclusions: This digitally delivered intervention is acceptable, appropriate, and feasible to support a hospital-initiated, community-based prehab program.

Increased allied health services to general and acute medical units decreases length of stay: comparison with a historical cohort.

Objective The present study evaluated the effect of an initiative to fund increased allied health (AH) services, enabling increased days and both volume and scope of AH services, for general medical in-patients in the Central Adelaide Local Health Network for a 6-month trial period. Methods A quasi-experimental mixed-methods study was undertaken involving general medical in-patients at two acute tertiary-referral public hospitals with a prospective (December 2015-May 2016) and historical comparison (December 2014-May 2015) cohort. Outcome measures compared between the two cohorts included hospital length of stay (LOS), occupied bed-days, adverse events and AH service data. Results After implementation of increased AH services, there were significant decreases in the median (interquartile range) of both hospital LOS (from 7.2 (7.0-8.0) to 6.5 (6.1-6.7) days; P=0.006) and occupied bed-days (from 5295.0 (5200.0-5622.3) to 4662.5 (4335.8-4744.3) bed-days per month; P=0.004). There was no significant change in weekend discharges or adverse events. AH services increased, with the median number of referrals seen by AH professionals per month, occasions of AH service and AH intervention time per month increasing by 17%, 45% and 43% respectively after implementation, along with a faster response time to referrals. Conclusions Increased levels of AH staffing to general medical in-patients were associated with a significant reduction in hospital LOS and occupied bed-days. What is known about the topic? AH services are an important component in the delivery of safe, effective and efficient health care to hospitalised patients. There is little evidence specifically investigating the effect of increased AH services for general medical patients in an acute hospital setting. What does this paper add? This study provides new evidence demonstrating that increasing AH services to general medical in-patients within two acute tertiary-referral public hospitals decreased hospital LOS and occupied bed-days, without an increase in adverse events. What are the implications for practitioners? A funding initiative to enable increased AH services to general medical in-patients significantly reduced hospital LOS and occupied bed-days. These findings will be of considerable interest to other healthcare centres, particularly those where AH levels are below benchmark figures.