October 30, 2023
For many of us, aches and pains are just part of life as we grow older. The more we age, the worse they get. So It should come as no surprise to anyone that as our population ages, the demand for joint replacement surgery is increasing, and this has significant implications for the health system.
Services like Hoki ki te Kāinga (HKTK) and Supported Transfer and Accelerated Rehabilitation Team (START) exist, in part, to help a growing number of older people recover from joint replacement surgery at home. The need for these services was outlined by New Zealand research published in Oct 2019. “Specialised teams and pathways to optimise perioperative care for the geriatric surgical population should be developed”. The same research points to a likely rise in demand for these services as our population ages.
These pathways comprise multi-disciplined teams that are instrumental in helping hundreds of older patients recover when they get discharged from hospital. According to the Waikato hospital webpage
“the [START] service has been proven to be effective:
• It delivers care in the person’s own environment and on their terms
• It helps them to achieve real life goals of their choice
• It reduces length of stay in the hospital
• It also supports the person to stay at home for longer and as a result halves the chances of the person being readmitted to hospital again.”
Like many parts of the health system, however, these services are under pressure. Patient capacity is limited by the number of staff employed by the service, and this means that some people miss out. This incurs a cost on the health system because the service cannot deliver benefits to as many patients meaning some patients must spend longer in hospital because they can’t be accommodated by these community-based programs.
Research that was recently published in Australia attempted to quantify some of these costs. The Australian Medical Association (AMA) analysis estimates that expanding access to out-of-hospital rehabilitation to all clinically eligible private patients having a total knee replacement would save around 47,000 to 94,000 bed days and $31.3 million to $62.7 million per year (in 2024).
Faced with growing demand for their services and limited staff, the Hoki ki te Kāinga team in Hawkes Bay is trialing new technology from Spritely to increase patient capacity so they can help more people. Spritely’s RPM system is adding capacity to the workforce by saving nurses time, which means the service can accommodate more patients each year. This means more nights will be saved due to shorter length of stays and less readmissions. Watch this video:
The New Zealand health system has already gone to a lot of effort acting on research to create these pathways for supported discharge and rehabilitation of patients in their own home. They exist all around the country to varying degrees of maturity. We now have growing evidence about positive patient outcomes and the number of beds nights that can be saved.
In Australia it has been claimed the service could save up to 94,000 bed days a year just for knee replacement patients. Imagine if the service was available to clinically eligible patients across other procedure and treatment categories (such as other orthopaedic procedures, stroke rehabilitation, mental health, and palliative care).
The positive economic impact would also be broader than just saved bed days, as patients may also experience reduced risk of infection, reduced travel (when the patient receives care in the home), enablement of work from home, and improved ability to manage caring responsibilities.
So my question is, having set up these services around New Zealand, wouldn’t we do everything possible to expand patient capacity within them? By equipping the hard working staff with digital tools that are proven to save them time and improve outcomes for their patients.
Every extra patient these services can accommodate each year (compared to the previous year) adds capacity to the hospital. It isn’t easy to build patient capacity by increasing the size of the team (due to workforce and cost limitations), but it is easy to add technology to the existing model of care in a way that makes a material difference to capacity. Spritely has already done it in Hawkes Bay. Who’s next?
