There’s excellence here – we just need more support
Published at 11:30, Thursday, 07 June 2012
With two young children, Sue Jefferson should have been running around enjoying time with her family. But just a year after her youngest daughter Lucy was born, she started to experience severe pains in her joints that left her virtually immobile.
“I didn’t know what it was. One of my knees was the worst. I couldn’t get off the sofa and struggled to get out of bed. At one stage I was in pain all the time. I just broke down.”
Sue, who was then in her late 30s, was eventually diagnosed with rheumatoid arthritis – a condition which causes a person’s immune system to start attacking healthy joints.
As a result, the cartilage in her knees and shoulder had been worn away. She needed three joint replacements – but being so young her GP was not keen for her to undergo the surgery as the replacements only have a life span of about 15 years.
Sue, who lives with husband Mike and daughters Alex, 14 and 12-year-old Lucy in Lowry Hill Road, Carlisle, says: “My doctor said I was too young but I told him I have two young children and they are only young once. Lucy was toddling at this point and I felt useless. I couldn’t do anything I wanted to do with them. I couldn’t even get in the bath or up off the floor. I said I can’t afford to worry about what’s going to happen in 15 years’ time. I need it now.”
Sue, now 49, was referred to orthopaedic surgeon Matt Dawson at Carlisle’s Cumberland Infirmary – who agreed she couldn’t wait. “He said let’s do it. I was so relieved.”
She went in for her first replacement, on her worst knee, about eight years ago. “It was a bit worrying but without the operation I was becoming more and more depressed. I went from being a young 38-year-old to an old woman overnight.”
The operation, a right knee replacement, was a success. However because she had lost so much muscle during her illness the rehabilitation was slow. But she persevered and it was worth it.
“The only way I can describe it was that I felt like I’d got my life back. The pain had gone and I could suddenly walk and get up without thinking.”
Initially the plan was to do the other knee soon after. But with the worst one done she decided to wait. In the meantime she had the shoulder operation, which also helped.
However last year the left knee started to worsen so she went back to see Mr Dawson. He arranged for the surgery and she went in for the operation after a short wait.
Although the first one had been a success, she said there had been so many advancements in just a few years that she noticed a real difference the second time round.
Where she had been in hospital for 11 days the first time, this time she was out in two. Also the drugs she was given were different, meaning she felt much better after surgery and ultimately ready to go home much earlier.
And that is not a rare occurrence. Led by Mr Dawson, the Carlisle hospital’s orthopaedic department has been pushing forward with a new initiative – called The Enhanced Recovery Programme (ERP) – to improve quality while at the same time reducing the length of stay for knee and hip replacement patients.
Mr Dawson explains: “This particular programme started in Denmark and was taken up at the Golden Jubilee Hospital in Glasgow, where they do 2,500 joints a year.
“It was just a case of people putting their heads together and setting about trying to improve things. They looked at different techniques from around the world and put them all together as part of a programme. We followed in their footsteps.
“Our aims are reducing lengths of stay and improve patient satisfaction with less pain, less nausea, quicker return to normality and ultimately happier patients.”
He explains that pre-op it’s about ensuring GPs and patients are educated about what’s going to happen. “Things have moved on. It’s about spotting things before the patient comes in – things like blood pressure, infection. It reduces illness and prevents cancellations.”
When a patient does come in, various steps are taken to improve the overall experience. Great attention is paid to explaining the procedure beforehand. “A patient with less anxiety is less likely to be in pain. It’s also telling them what to expect. If a patient is fully informed then things tend to happen the way you plan them,” he adds.
Mr Dawson’s personal record shows nausea and vomiting after operations has dropped from 70 per cent to 20 per cent, while length of stay is now three days – ahead of the national average.
He added that this is particularly good as the Cumberland Infirmary does not, like many hospitals, just select simple procedures but also carries out the most complex cases.
So far this year Mr Dawson has given presentations about the hospital’s results to the National Audit Symposium and National Pain Symposium.
“Our success has got some beef behind it – these are not idle claims.
“We do 275 knee replacements a year but that is growing. Hips are staying fairly static. People are getting older and there is growing awareness that in the right person a knee replacement is perhaps more applicable than it used to be. Patients are becoming less scared of coming forward so we are doing more and more.
“Patients generally speaking come in and are going home in three days, in fact it is not uncommon in two days. In the past consultants would have patients in for 10 days or even two weeks. One of our consultants has halved their average from 10 days down to five days just by doing this. That is far better for the patient.”
Mr Dawson adds that the ERP is not just about what happens in hospital but also ensuring the right support – such as extra physio or home support – is available when they are discharged.
“With proper planning there’s no reason why age should slow you down. I’ve had elderly and infirm patients going home on day three.
“We call in enhanced recovery. Other people have called it fast-track or accelerated but I don’t like those words. It’s about improving something rather than just making it quicker. Saying that, it’s perfectly reasonable to measure success by speed because if a patient goes home quickly it shows you’re doing it right,” he explains. “People have asked why this hasn’t been taken up by every hospital. I think it’s personalities, traditions etc. My job was to get the whole team involved – surgeons, anaesthetists, nurses, GPs, occupational therapists and physiotherapists. It was about getting them all to sing from the same hymn sheet.”
Because of the ERP, they are now freeing up more beds by getting people home sooner. Mr Dawson believes the department can now grow and hopes for more surgeons to be appointed after the trust is taken over by new bosses from Northumbria.
He says they are also now doing a lot more specialist work, such as realignment procedures, to benefit young patients.
Anna Stashkiw, now 21, of Wetheral, had suffered from problems in her right knee since she was about 11. It was made worse by a skiing accident a few years ago, which is when she went to see Mr Dawson.
“It had always held me back. Right through my teens I couldn’t do much sport and what I did do I really struggled with,” she explains.
In 2009, just after finishing her A levels, she went in for realignment surgery. She spent the summer recovering, but it has given her a new lease of life. Now a student at Dundee University, she is now a dedicated member of the rowing team – something she couldn’t even have dreamt of a few years ago. “I love it. It’s one of the best things I’ve ever done,” she adds.
Mr Dawson believes the Carlisle orthopaedics department can now start thinking big, and is urging new bosses to invest and build on the good work that has already been done.
“In the 10 years since I’ve been here this hospital has never really been aspirational and I think it has been under-funded. We have got excellence here, it just hasn’t been supported.
“This hospital has got an awful lot of good clinics. We’ve kind of been swamped by bad news that is out of our control in the past few years. However we’ve got some very good things going on and could do more with better support,” he adds.
Published by http://www.newsandstar.co.uk