Patients watch as joint replacement surgeons cut stays

PEOPLE wondered how Circle was going to make money out of running Huntingdon’s Hinchingbrooke Hospital. By giving clinicians their heads, the company said.

Seven and a half months into the 10-year franchise, the hospital’s orthopaedic department has almost halved the length of patients’ stays after hip and knee replacements.

The additional beds mean the Huntingdon hospital is now taking on operations that were booked to have taken place at Addenbrooke’s in Cambridge but can now be done sooner at Hinchingbrooke.

Consultant orthopaedic surgeon Arpit Patel, who has been at Hinchingbrooke since arriving as a senior house officer in 1997, told The Hunts Post: “Addenbrooke’s is struggling for capacity for the joint replacements that we are doing. That translates into revenue for us.”

Part of the key to reducing the length of stay lies in streamlining the operation process – not rushing the surgery, Mr Patel insists, but ensuring the patients are as fit as possible and ready for the surgeon as soon as theatre space is available, and that there is a standard protocol for anaesthesia.

“Some surgeons do four joints a day and some do three. I can’t ask a surgeon to operate too quickly, but I can make other elements of the process more efficient.

“A lot of doctors wanted to make changes. What Circle has done is to have facilitated those changes. For example, I visited a small joint replacement facility in Glasgow where there they have an anaesthetics protocol that I wanted us to follow.

“Previously, that decision would have been a nightmare. Now, with so many clinicians on the board, we can do it in a few days. I’m very excited about that.”

The result has been a dramatic reduction in the average length of stay after a joint replacement down from 5.4-5.6 per cent when Circle took over to 3.1 days now, without any change in the readmission rate to deal with complications.

The other benefit is that joint replacement operations – usually the first casualties of beds being taken up by patients with winter chest infections – are now less likely to be cancelled.

What’s more, patients can now watch their operations as they happen. Lower limb joint replacements are usually carried out using spinal anaesthesia, so patients remain conscious. Equipment in the theatre means they can watch a three-dimensional diagrammatic representation of the surgeon’s work – “they see a cartoon picture of the leg,” Mr Patel said.

“I have had engineers [as patients] who have looked at what I was doing to their knees, but most patients would find that gross.”