Abstract / Summary
Abstract Background Approximately 250,000 total hip and knee replacements were performed in the UK in 2024. One in five patients who have a knee replacement and one in seven who have a hip replacement are dissatisfied with their outcome and/or have chronic pain after surgery. Some report feeling abandoned and have expressed a need for more advice and support. Some patients will have their operation cancelled at short-notice, which negatively impacts patients’ quality of life and relationships with healthcare professionals, and results in a lost NHS tariff opportunity of up to £11,000 per cancellation. Continuity of care is important for patient satisfaction and has been shown to improve outcomes in several clinical specialities. This approach to delivering care has the potential to improve patient outcomes and satisfaction through provision of tailored treatment, support and education. Pre-operative health optimisation may also reduce short-notice clinical cancellations. This project used co-production to develop a care plan for patients delivered by a named contact, before and after surgery. Methods The intervention was co-produced by a group of 5 researchers, 5 health professionals and 5 patients, who met six times throughout the project. A long list of intervention components was developed, informed by informatics data collected on surgical cancellations and qualitative interviews with 20 patients and 20 healthcare professionals. A 2-Round modified Delphi study was conducted with 111 patients and 79 healthcare professionals to gain consensus on the intervention components and design. Results My Knee/Hip Plan provides health optimisation, information and prehabilitation from listing, allowing patients to understand how to prepare and be as healthy as possible for surgery. It continues to monitor patients while they wait, checking their health status with reminders to stop certain medications before surgery, and provides support during recovery. A dedicated helpline is available from listing to three months after surgery, with advice and support for those who need it. Conclusions My Knee/Hip Plan is a co-produced care pathway to optimise care from listing to 3 months post-operative. It aims to decrease avoidable surgical cancellations and improve patient outcomes. Further work is needed to evaluate clinical and cost-effectiveness. Registration ISRCTN76980954