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Implementation and effects of Enhanced Recovery After Surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services.

AIM
The National Orthopaedic Enhanced Recovery After Surgery (ERAS) Collaborative was launched in November 2013 to implement ERAS protocols for hip and knee total joint arthroplasty (TJA) and fractured neck of femur (NOF) in participating district health boards (DHBs) by December 2014. This paper reports on the results.


METHOD
ERAS protocols were developed for hip and knee TJA and fractured NOF. Breakthrough Series collaborative methodology was used to implement the ERAS protocols in 18 DHBs. We collected monthly data on compliance with protocols and average length of stay (ALOS). Data were analysed using run charts and Shewhart control charts.


RESULTS
The national percentage of ERAS components achieved across all DHBs rose from 33% to 75% on the elective knee TJA pathway, from 31% to 78% on the elective hip TJA pathway and from 29% to 51% on the acute fractured NOF pathway. The ALOS for knee TJA reduced from 5.4 days to 4.5 days. The ALOS for hip TJA reduced from 5.1 days to 4.3 days. There was no change in the ALOS for fractured NOF.


CONCLUSION
The National Orthopaedic ERAS Collaborative increased uptake of ERAS protocols across all three pathways and decreased ALOS for the elective pathways among participating DHBs. There was no decrease in ALOS for the fractured NOF pathway. Collaborative improvement methodology can be used successfully to implement orthopaedic ERAS across New Zealand DHBs.