Introducing a Fast Track for Patients Undergoing Arthroscopic Subacromial Decompression and/or Rotator Cuff Repair
The prolonged length of stay (LOS) after Arthroscopic Subacromial Decompression (ASD) and Rotator Cuff Repair (RCR) is having an adverse effect on the efficiency of the healthcare system. Improving the time patients remain in hospital after surgery will have a positive impact on the patient and on the healthcare providers. The aim of this Quality Improvement Plan (QIP) is to reduce the LOS after ASD or/and RCR designing a Fast Track to allow patients to access these procedures as Day Case. Using the DMAIC (Define, Measure, Analyse, Improve and Control) framework for Quality Improvement (QI), the journey of patients undergoing an ASD and/or RCR procedures was reviewed. QI tools such as a stakeholders analysis, fishbone diagram, process flow maps and data collection were applied to identify the ‘root cause’ of the problem and to recommend changes. The results indicated patients are staying in hospital for an average of 2.1 days, negatively impacting on waiting times for ASD and/or RCR procedures, which at the time of this plan was up to 24 months. It will be proposed for a pre-operative scoring system to be introduced to facilitate healthcare professionals in identifying those patients better suited to undergo ASD and/or RCR procedures using the Fast Track approach. This will ensured these procedures could be performed as Day Case permitting an early functional recovery, subsequently reducing the LOS after surgery without increasing complication rates.