Success Story: Getting Patients Home Faster

When Dr. Duncan Jacks initiated Victoria Enhanced Recovery Arthroplasty (VERA), a same-day arthroplasty program in Victoria in 2019, he did so in recognition of the value of getting patients home safely on the same day as their surgery. Patients appreciated not having to spend the night in the unfamiliar setting of the hospital, and Island Health was able to free up hospital bed space for other patients.

What he could not have anticipated at the time was the advent of COVID-19 just a few months later. For several months in early 2020, all elective surgeries were put on hold. Patients who had been scheduled for a knee or hip arthroplasty had to wait until the immediate threat of a sudden surge of COVID-19 infected patients had subsided. Yet with the constant threat of a second wave, keeping hospital beds free is now doubly important. Suddenly, a same-day discharge arthroplasty program became part of the hospital’s way of managing the limited resources of hospital beds.

Dr. Jacks’ project received funding in its first phase to engage across multiple departments to establish the necessary protocols for the same day program and to design and implement a pilot of the same-day service. Following a meeting with Island Health CEOs in the fall of 2019 where Dr. Jacks presented the results of the pilot, he felt confident that all stakeholders were aligned in support of this initiative.

In Phase 2, Dr. Jacks and colleagues Dr. Jacques Smit and Dr. Tristan Camus completed the Clinical Order Set for Same Day Hip/Knee Arthroplasties by meeting with their Island Health counterparts, physiotherapists, Clinical Nurse Leads, and pharmacists. Gathering the group together via teleconferences, they discussed and debated necessary modifications to make a same-day discharge program function safely, including multimodal pain management, and adjustments in the activity orders for patients post-surgery. They also drafted a health care provider user manual for VERA – a ‘cookbook’ for the initiative – that can be implemented by others in Victoria or at other sites without the direct involvement of Dr. Jacks or his other colleagues.

In an example of parallel initiatives benefiting each other, Dr. Jacks’ project builds on another project initiated by a South Island physician, Dr. Gus Chan. While Dr. Jacks has been working to scale up the VERA project, Dr. Gus Chan and his colleagues in anesthesia have been working to build consensus and refine protocols around the creation of a block room, a designated space to administer regional anesthesia. The absence of a block room was one of the biggest obstacles identified to implementing a same-day discharge for arthroplasty, as patients would have to queue for their spot in the operating room before having anesthesia administered. In May 2020, the Victoria Block Room entered its pilot phase, a shift that will no doubt impact on the efficiency and functioning of the same-day arthroplasty program.

With the continuing imperative of keeping the hospital census to a minimum, the VERA initiative stands out as a leader in same-day discharge. We congratulate the project leads on their hard work getting the project launched and look forward to further scale-up and expansion in the coming year.

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