Discharge from the hospital

Most patients are keen to get home from hospital as soon as possible. Research has shown that early discharge from hospital and early return to normal duties are associated with a better recovery and more patient satisfaction. Depending on your procedure however there are several barriers which have to be cleared for what we consider a “safe” discharge.

There is no point in leaving before you are ready, to struggle unnecessarily at home or have to have a return visit to sort out problems. Suitability for discharge is therefore a very important,structured  multidisciplinary decision.

Several members of the team, nurses, physiotherapists, occupational therapists as well as doctors need to be sure that you can manage safely. In particular, lower limb surgery by its very nature will have some effect on your mobility. However the vast majority of problems can be solved fairly easily.

Pain relief

Pain relief starts before you even come into hospital by understanding what is going to happen to you and how you are going to cope with it. After surgery, many different modalities I used to help with pain relief. temporary splintage with early mobilisation, is probably one of the best forms of pain relief and would be probably counterintuitive to most patients. However, early movement of a recently operated joint, in fact is the best kind of pain relief in the long term.

After surgery, it is quite common to use nerve blocks or regional blocs that will reduce pain in the immediate post-operative surgical period. This will get you over the worst of things and give you confidence on the next stage.

Naturally, painkilling drugs can be given but they all have side effects and the aim is to maximise the pain relief and reduce the amount of side-effects such as drowsiness, nausea, constipation. By the time you leave hospital you should be on simple oral medication.

During your stay, apart from mobilising your joint, the physiotherapist may apply such techniques as the cryocuff, which is basically a cooling apparatus placed around a recently operated joint.

Use of crutches and there to help balance and confidence although it would be hoped that fairly soon you will be able to manage without them.

Mobility and balance

Mobilisation after surgery is the keystone of success. If pain can be controlled and swelling limited, mobility will accelerate. Anticipation of problems and lack of confidence are much more important than simply dealing with the discomfort of a surgical procedure and the physiotherapist will teach you techniques to mobilise, improve your confidence to the point when you can function at home

Aids and appliances

Crutches as mentioned above are a useful adjunct to get people on their feet and used to the idea of mobilising as soon as possible. This in turn generates benefits is paying is diminished after exercise and use of a recently operated joint. Again, crutches and supports are used in an attempt to get you back on your feet as soon as possible ultimately with the aim of removing them as quickly as you can stop

Community backup

Discharge from hospital does not mean your treatment is finished or that you have recovered. The hospital phase of treatment should be regarded simply as that; the period at the beginning of your surgical treatment. The vast majority of recovery will occur at home as you continue to mobilise your injured joint, with specific exercises and routines given to you by your physiotherapist. Most simple activities like removal of sutures and dressing changes can be performed in the community whilst you are recovering.

Procedure and follow up information

You are usually reviewed at least once after surgery at an appropriate time to make sure your recovery is going according to plan. At first post-op visit is an important time in which the patient can express their concerns and appreciation of their progress and the surgeon can assess them as to the degree of recovery. This is a good time to discuss any unanswered questions, or queries about progress on where to go to next. Traditionally, doctors do review patients after surgery to gauge progress, to provide encouragement and answer questions although in reality, the patient is doing all the hard work!

After a suitable time assuming full recovery, you will be discharged from your consultant, often with the offer to return if there are problems or concerns in the future.

Accelerated rehabilitation

You may be aware of this term either from your own research or from having spoken to the rehabilitation team in charge of your case. Effectively this means application of all the categories mentioned above to maximise and speed up your recovery. It should not be seen as a negative aspect, aiming for an early discharge from hospital. Research has shown that patients in the long term make better progress and appreciate less time in an unfamiliar environment. This largely begins with matching expectation to reality so that patients understand that when they come into hospital for a procedure, it is generally much easier than the anticipated.

One of the biggest barriers to progress are the preconceptions what will happen to you in hospital. Most patients tend to feel that bed rest and gentle slow progress is the best way however, over the last few years we have realised that this is in fact detrimental to patients and we are aiming to get people out of bed and mobile on the day of surgery if possible. Using all the techniques available to us in terms of pain relief, mobilisation, preoperative education and preparation for a planned discharge date in fact leads to patients making much better recoveries in a much quicker time. Do not be scared, the vast majority of people do perfectly well and the function of your rehabilitation team is to facilitate this and to help you with things do not always go exactly to plan.

In any event, you will leave hospital feeling confident and well aware that you are recovering and on the way back to normal in a much shorter time than you would normally appreciate.

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