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Implementing the OACCP at Dubbo Base Hospital Craig Lennox Senior Orthopaedic Physiotherapist Dubbo Base Hospital May 2012
Implementing the OACCP at Dubbo Base Hospital
Craig Lennox Senior Orthopaedic Physiotherapist Dubbo Base Hospital May 2012
Dubbo
Dubbo
• Population: 42,108 (June 2011) • Average Age: 35.7 • 12.8% of population >65 years • 25% predicted to be >65 by 2036
Dubbo Base Hospital
• In the Western NSW Local Health District
• Referral centre for large geographical area
• People travel over 4 hours
Orthopaedics at DBH • Pool of visiting orthopaedic consultants,
primarily from Royal North Shore Hospital led by Dr Stephen Ruff
• 2 registrars on 6 month rotations • Elective joint replacement in 2011:
2011 TOTAL Age (av.) F:M (%) LOS (av.)
THR 87 73 51:49 5.4
TKR 84 66 60:40 4.6
Hip/Knee OA Management
January 2011 • People with hip/knee OA referred to Orthopaedic
Clinic • Put on waiting list or “wait and see”
– Occasional referrals to physiotherapy and told to “lose weight”
• No further pre-op management until surgical preadmission clinic
Hip/Knee OA Management • 6 weeks pre-op pre-admission clinic
– Nurse, anaesthetist, pain nurse, orthopaedic intern/resident assessments
– Physiotherapist assessment with provision of education and exercise sheet
• Joint replacement surgery – Inpatient physiotherapy, occupational therapy, nursing, social
work/ARC nurse, medical/orthopaedic management
• Discharged with outpatient physiotherapy referral, aids/home modifications, other services
• Orthopaedic review at 6 weeks and 12 months
Implementing the OACCP
• Goal for 2011 to begin a “Pre-Op” program for people electing total hip/knee replacement – Disease management and health education – Multidisciplinary team interventions – Aim to improve post-op results
• Independent planning began in January 2011 – Research on evidence for pre-op MDT interventions – Planning use of staff, facilities, tools
Implementing the OACCP • “Heard” similar groups existed at several
hospitals, including Nepean • Introduced via email to the OACCP • Plans modified to fit OACCP • Program proposed to and accepted by Dr
Ruff • Dubbo site incorporated in October 2011 • First assessment performed 16/11/11
Utilising Existing Resources
Utilising Existing Resources • Multiple staff members involved in
assessments: – Chronic Care
• Co-morbidity and medication screening • 6MWT, TUG, Hip:Waist Ratio, BMI
– Outpatient Physiotherapy • VAS, questionnaires review, objective measures,
goals, education – Physiotherapy Assistant
• Data entry
Utilising Existing Resources
• Referrals are made to new or existing sources: – New physiotherapist-run exercise and
hydrotherapy classes – Community health or private dietitians – Outpatient physiotherapy in peripheral areas
New Resources • Land-based Physiotherapy class
– Weekly 1-hour class, began 28/11/11 – Run by outpatient physiotherapist with
physiotherapy assistant – Incorporates bed, chair and standing exercises – Focus on strength, ROM, balance and
proprioception – Education, objective assessment and exercise
progression incorporated
New Resources
New Resources • Hydrotherapy Class
– No hydrotherapy at DBH, so agreement reached with local rehabilitation hospital
– Weekly 1-hour class began 27/2/12 – Run by DBH outpatient physiotherapist using
hydrotherapy pool at rehab hospital – Simple strength, ROM, balance and
relaxation exercises – Very popular
New Resources
Results • Classes currently full • Waiting list for both assessments and
classes • 4 people re-assessed
– 2 of 3 original goals acheived – 2 improved TUG and 6MWT – BMIs stable
Results • Subjectively, participants are very happy • Reporting
– Less pain – Improved function eg. ability to walk up stairs – One person now able to run short distances,
sit on the floor cross-legged, and on orthopaedic review decided he no longer wanted to go on the TKR waiting list
Success!
The Future • Chronic Care EEN leaving
– Reduced CC availability in short term – Increased load on outpatient physiotherapists
• More dietitian referrals – Increase use of available services
• Begin short education sessions – Half-hour weekly multidisciplinary education
including physiotherapist, occupational therapist, pain team
Craig Lennox Senior Orthopaedic Physiotherapist
Dubbo Base Hospital
