Yoeri Bemelmans

Chapter 11 168 An indispensable role is held for the surgeon and PA; they are the representatives of the newly addressedworkflow and should be on theward, operation room, post anaesthetic care unit (PACU) and the outpatient clinic to answers questions and guide colleagues through the implementation process. After the implementation of the newly designed protocols, the evaluation should take place as outlined in this thesis on several topics within the clinical pathway. In first place, results regarding patient’s clinical data should be gathered and monitored on those subjects whom delay or negatively influence the patients’ journey (e.g. pain experience, PONV, urinary retention, wound complications, early mobilization). Secondly, adequate and repeatedly review of the literature should be done. To adjust the implemented protocols, the multi-disciplinary team should collaborate and provide regular consultation to adjust when deemed appropriate, which includes the final ‘act’ step of the PDCA circle. Final remark By optimising the pre-, peri- and postoperative protocols, clinical pathways for hip and knee arthroplasty successfully resulted in well-established concepts such as fast-track surgery and OJA. With the aims of improving postoperative recovery in terms of lower morbidity and mortality with comparable or even improved PROMs and thus patient satisfaction. These improvements consist of evidence-based treatment modalities which are based on the reduction of surgical stress response and with an additional optimised logistical process. But most important, tailored information to the patient is crucial. Especially when implementing an OJA pathway, patients preoperative planning is of paramount importance. Patients need to know and understand the process to create the correct mind-set for discharge on the day of surgery to their home- environment. Future research strategies should focus on a further evaluation of safety (e.g. (S)AEs, readmission rate) and efficacy (e.g. pain management, blood management, early mobilization, discharge criteria) aspects of OJA, substantiated with evidence- based patient selection criteria with as major goal improving patients healthcare and satisfaction while reducing healthcare costs.