Implementing an innovative, patient-centered approach to day case arthroplasty: improving patient outcomes through remote preoperative pharmacist consultations

Abstract

Objective Elective surgery suffered significant loss of capacity during the COVID-19 pandemic. To address this, hip and knee arthroplasties are being conducted as day case procedures. Pre-admission pharmacist consultations were introduced (the intervention) for these patients. This consultation aimed to address perioperative medicines issues, promote patient empowerment, improve prescribing quality and contribute to reduction in length of stay (LoS). Methods All patients listed for a total/ unicompartmental knee replacement (TKR/UKR) or total hip replacement (THR) at an ambulatory care hospital were identified by a pharmacist prescriber 1-2 weeks before the operation. Pharmacist consultations were conducted remotely with discharge prescriptions written electronically and dispensed before admission. Prescribing data were collected for both pre-intervention (n=80) and post-intervention (n=129) groups along with all interventions undertaken during consultations. Staff opinion was sought via online questionnaire and patient opinion was gathered via post-discharge telephone calls. Results A total of 115 interventions took place during 129 patient consultations and >75% of interventions were of a significance expected to improve patient care. Prescribing standards were improved in the intervention group compared with patients whose arthroplasty was before the introduction of this service. The pharmacy service would have produced a different prescription in 38.8% of the pre-intervention group. Staff and patient feedback was extremely positive and all patients with previous surgical experience in the health board reported an improved experience. There was a statistically significant reduction in post-discharge healthcare encounters (such as general practitioner (GP) visits) in the intervention group. Conclusion This novel remote preoperative pharmacist consultation improved prescribing standards, enhanced the patient's surgical experience and reduced the burden on post-discharge healthcare systems.

Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis

“…The majority of studies were conducted in the United States ( n = 9; 36%) 32 – 40 and China ( n = 9; 36%), 41 – 49 followed by the United Kingdom ( n = 3; 12%), 50 – 52 and one (4%) each in Australia, 53 Netherland, 54 Pakistan, 55 and Sudan 56 ( Table 1 ). Most of the studies ( n = 8; 32%) were carried out in orthopedic surgery, 35 , 37 , 38 , 41 , 44 , 47 , 49 , 52 followed by five (20%) studies each that included multiple units 43 , 53 – 56 and general surgery 39 , 42 , 46 , 50 , 51 ( Table 1 ). Three studies (12%) were conducted in bariatric surgical units, 33 , 34 , 40 and two (8%) each in cardiothoracic 36 ,…”

“…The majority of studies ( n = 20; 80%) used an uncontrolled study design, 12 (48%) retrospective, 32 – 34 , 37 , 39 , 41 , 42 , 45 , 46 , 49 , 51 , 52 5 (20%) prospective, 35 , 36 , 43 , 50 , 55 3 (12%) retro-prospective studies, 40 , 44 , 48 with a variety of observational methodological designs ( Table 1 ). The remaining five (20%) were controlled, all of which were randomized.…”

“…The remaining five (20%) were controlled, all of which were randomized. 38 , 47 , 53 , 54 , 56 Follow-up duration among the included studies ranged from 9 days 52 to 36 months. 41 …”

“…Fourteen studies (56%) reported that patients were the target of the implemented pharmacist-delivered services, 33 – 35 , 38 – 40 , 44 , 45 , 47 , 50 – 54 while seven studies (28%) reported that patients alongside medical staff were the recipient of the intervention. 32 , 36 , 41 , 43 , 46 , 48 , 49 Four studies (16%) reported that the pharmacist intervention was intended for medical staff, mainly surgeons with or without other healthcare providers such as nurses or anesthesiologists.…”

“… 49 , 50 Two studies (8%) only included educational initiatives and were conducted in the hospital, 55 , 56 while one study included both delivering education in the hospital and interviewing patients in their homes. 36 Two interventions took place only at the recipient’s home 38 , 52 and one in a hospital-based clinic. 34 …”