• Patients benefitting from new ways of working to reduce hospital stays after joint surgery
• February saw Bolton’s first-ever same-day discharge for a hip replacement
• Initiative is unlocking capacity to help tackle unprecedented backlogs and waiting lists

Joint surgery patients at Royal Bolton Hospital are now able to return home much sooner thanks to “game-changing” new ways of working.

A new initiative is aiming to drastically reduce the number of days patients need to stay in hospital after knee or hip replacements.

A review of the care patients receive, both before and after surgery, identified areas where changes could be made to support patients back to the comfort of their home:

• Pain management after the operation
• Introducing physiotherapy on the day of operation
• Implementing and adapting processes used by specialist surgery centres

Figures from Bolton NHS Foundation Trust reveal the average length of stay has seen a drastic reduction, halving from three to four days in 2022 to one day in January 2024.

February also saw Bolton’s first-ever same-day discharge for a hip replacement.

Graham Marsh, 75, from Farnworth is among those to have enjoyed being able to return home sooner. In January 2024, Graham received a full hip replacement, and by the next evening was back home with his wife of nearly 40 years, Julie.

I was very happy to be home. The morning of the operation they said if all goes well I may be back home by tomorrow. I was made to feel very relaxed and I can’t speak highly enough of the personal support I had from my surgeon.

Once home, Graham continued to receive regular support and advice from a physiotherapist to ensure he had the best possible recovery.

My physio was very informative and talked me through what I had to do – no cheating of course. It’s easy when something hurts to give it a miss. I was determined to do whatever they said as they are the brains of the operation. Don’t start running before you can walk, because your body does tell you.

“Being home helped with my recovery. I can do things in my own time, in my own space. If I wanted to go and have I lie down I could. I could speak to people on the phone, I have a good home life.

Due to the Coronavirus pandemic Graham’s surgery had to be postponed, which left him in a lot of pain and made daily tasks a struggle.

Three months after the surgery, Graham has experienced a huge difference in what he is now able to do and is enjoying be able to get back to things he loves.

Before the operation the pain was pretty bad. I could never get comfortable in bed. We’ve got a dog which we have always walked whatever the weather, but my hip played up to a point where I couldn’t do the regular walk to Farnworth anymore.

“It got to a point where even lying down I was struggling with. All of the things we take for granted.

“Now I’m on a two hour walk with our dog. We go over to Haigh Hall near Wigan, it’s a bit hilly but I cope with it. The surgery has transformed my life. I’m no longer apprehensive about whether I can manage to do things. When I’m in bed I can turn over nice and bonny.

“Looking back I was living with the discomfort and pain and it became a way of life. Now I’m pleased I can enjoy the small things again.

The initiative is unlocking bed and theatre capacity to help tackle unprecedented backlogs and waiting lists.

Dominic Marley, Consultant Trauma and Orthopaedic Surgeon at Bolton NHS Foundation Trust, said:

We know that for many of our patients being able to return to the comfort of the place they call home is best for their recovery after surgery.

“In some cases we’re even able to discharge the patient just hours after their operation by making sure they have all the information, medication and physiotherapy techniques they need, with regular check-ins over the phone to make sure they are comfortable and happy.

James Childs, Consultant Trauma and Orthopaedic Surgeon at the Trust, added:

Through an holistic care approach and engaging with physiotherapy on the day of the operation we’ve been able to reduce pain levels for our patients.

“Patients are offered reassurance every step of the way and we’re empowering them with the information they need so they know what to expect, understand how to manage their recovery, whilst being able to experience quality time in the comfort of they place they call home.

Kim Ashcroft, Ward Manager in the Elective Care Centre at the trust, said:

“Everyone in the department has come together to make these changes happen and it’s incredibly rewarding to see the positive impact it’s having on our patients by reducing the amount of time they need to stay in hospital.

“The changes we have made are allowing us to make much better use of the resources we have by increasing our surgical bed capacity, allowing our surgeons to carry out even more procedures, and reducing our waiting lists and the time it takes to be treated.

The NHS in Greater Manchester has valuable information and advice to help manage physical and mental wellbeing while waiting for hospital care. Find out more at whileyouwait.org.uk.