Yoeri Bemelmans

Chapter 11 166 When the fast-track pathway is enrolled as daily clinical practice, a further development of the pathway could lead to outpatient joint arthroplasty (OJA). The ultimate goal of OJA is not the discharge itself on the day of surgery, but rather the ambition towards perfection of the pre-, peri- and postoperative process which leads to the ability to safely discharge patients on the day of surgery, while maintaining or even improving patient satisfaction. During the past decades, OJA pathways are increasingly implemented, with success [12-14]. Asmost of the papers included the rather healthier and younger patients, the selection process of patients is of crucial importance [15,16]. Valuable information is stated in this thesis regarding the role of patient selection for these OJA pathways. The selection criteria are paramount to prevent for these (S)AEs and thus readmissions. Future research should focus onmore precise criteria to extended OJA to daily practice and provide a choice for our patients (fast-track or OJA). These selection criteria are not solely based onmedical conditions (or arguments), but also patient’s wishes are of (even more) importance. Several studies highlighted the preoperative education towards, for example, discharge on the day of surgery. One of the main reasons for discharge on the day of surgery is fear [17,18,19]. To prevent these delayed discharges, this fear has to be allayed. In first place by providing adequate information before surgery, for the patient as well as their relatives/caregivers. Adequate information on forehand can adjust postoperative expectations [20,21] and create the basics for preoperative preparation of their home-situation. After surgery, patients should be monitored closely to prevent for (S)AEs and/or readmissions. Future research holds an important role to optimise this monitoring. These days, several steps are alreadymade towards better understanding andoptimising the patients’ recovery after discharge, laid out in digital solutions (e.g. applications, smart-watches, health-care information systems, tele-rehabilitation) but need further evidence-based support for implementation in daily practice [22,23]. Toconnect thepatients’ needs,medical interventionsand the in-hospital logistical process, acasemanagerorproject leader should ideallybeappointed. It isof paramount importance to appoint a project leaderwhichhas substantive knowledge of the arthroplasty operation itself in first place, but more importantly, has insight in the complete patient ‘journey’ regardingthearthroplastysurgery.Aphysicianassistant (PA), aspeciallytrainedhealthcare professional (e.g. former physiotherapist, nurse, scrub nurse) who is certified to provide lowcomplexmedical services without direct supervision, can fulfil this position [24]. The PA has knowledge and experience with this process and is able to oversee the different stages during the patients’ journey. Potentially, it will reduce the surgeon’s workload by taking over the work regarding the evidence-based drafting and implementation of the perioperative protocols. As a clinically trained healthcare professional, the PA is able to