Total hip replacement - College of Occupational Therapists

Guideline recommendations
contribute to and inform multidisciplinary discussion and future practice developments.
An interesting article by O’Donnell et al (2006), while very low evidence, offers a
descriptive account of how a Canadian team examined the available evidence and
undertook a consensus process to develop primary total hip replacement guidelines for
their service. It is vital that occupational therapists proactively engage in the ‘hip
precautions debate’, and O’Donnell’s therapist- led/co-ordinated consensus project could
provide useful information about how this process might be taken forward locally.
18. It is recommended that occupational therapists consult with the surgical
team regarding any specific precautions to be followed post- operatively.
(Hol et al 2010, B; Peak et al 2005, B; Restrepo et al 2011, B; Stewart and
McMillan 2011, C; Ververeli et al 2009, B)
19. It is recommended that occupational therapists advise service users,
where protocol includes precautions, on appropriate position behaviours
for those daily activities applicable to the individual’s needs, ranging
from getting in/out of a car to answering the telephone.
(Drummond et al 2012, C; Malik et al 2002, D; Peak et al 2005, B; Stewart
and McMillan 2011, C; Ververeli et al 2009, B)
20. It is suggested that due to the uncertainty surrounding the need for hip
precautions, and the potential for an increase in satisfaction and early
functional independence when hip precautions are relaxed or
discontinued, occupational therapists engage in local discussion/review
of the emerging evidence with their surgical and multidisciplinary
teams.
(Drummond et al 2012, C; O’Donnell et al 2006, D; Peak et al 2005, B;
Restrepo et al 2011, B; Ververeli et al 2009, B)
1 B
1 B
2 B
7.5 Decreased length of hospital stay
7.5.1 Introduction
The period between admission and discharge for routine elective surgery has reduced in
recent years, with a median length of stay recorded as 5 days for total hip replacement
in England during 2009/2010 (Health Service Journal 2011). In Scotland, the average
length of stay in 2009 was reported as 6.2 days, with 35 per cent of service users being
admitted on the day of surgery (NHS National Services Scotland 2010).
The NHS Institute for Innovation and Improvement indicates that it is difficult to
improve length of stay without engagement from the multidisciplinary team involved
in the care. Clinical pathways in high quality and efficient services are underpinned
by a number of factors, including consistent management of service users’
expectations; surgery on the day of admission; mobilisation within 12–18 hours of
surgery; and criteria- based discharge (NHS Institute for Innovation and Improvement
2006).
A procedure such as total hip replacement is relatively standardised, and has, therefore,
been appropriate for the focus of care pathway activity, particularly given that
variations in the process of care can potentially be reduced. Care pathways, accelerated
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