NHS webinars roll out day-case hip and knee pathway checklist to expand same‑day arthroplasty

The NHS material behind the push for same-day hip and knee replacement is more practical than promotional. GIRFT’s March 2023 guide on ambulatory hip and knee replacement says safe elective primary arthroplasty can be delivered using “ambulatory pathway principles” with a default 0- or 1-night stay, while CPOC’s September 2024 Day Case First delivery pack says day surgery should be considered from referral and treated as the default option where appropriate. (cpoc.org.uk) That framing matters because the guidance does not present day-case arthroplasty as a single intraoperative win. (gettingitrightfirsttime.co.uk) The documents instead describe a whole-pathway redesign involving patient selection, expectation-setting, discharge competencies, therapy provision and post-operative support. ### So what are NHS teams actually being told to change? The September 2024 Day Case First pack says trusts should consider the day surgery pathway “from the point of referral for surgery” and says a multidisciplinary team, including managers, is vital to delivery. (gettingitrightfirsttime.co.uk) It also says, “Now is the time to consider day surgery as the default option.” The March 2023 GIRFT orthopaedic guide applies that logic specifically to hip and knee replacement. It says all patients should be placed on an ambulatory pathway by default unless they are identified in advance as needing higher-level postoperative care. (gettingitrightfirsttime.co.uk) ### Why does the guidance keep pushing the pathway back to listing and referral? CPOC, GIRFT and BADS say the gains from day surgery come from more than shorter stays. The Day Case First pack says expanding day surgery can reduce waits for planned care and reduce pressure on beds needed for emergency surgery. (cpoc.org.uk) GIRFT’s orthopaedic guide says centres that redesigned pathways achieved much shorter lengths of stay without compromising patient experience or care, and says shorter stays can help protect ring-fenced elective beds. That is why the guidance starts before the operation: discharge planning, social support, transport and patient expectations have to be built in early. (gettingitrightfirsttime.co.uk) ### What does the checklist look like in practice for hip and knee replacement? GIRFT’s guide says successful services use “highly refined clinical pathways,” default 0- or 1-night stay planning, documented discharge competencies and extended therapy support until 20:00 on elective operating days. (cpoc.org.uk) It also says patient education programmes should embed the expectation of a 0- or 1-night stay as the default. In practice, that points to a consistent bundle: careful selection at listing, structured optimisation before surgery, anaesthetic and analgesic plans that support rapid mobilisation, therapy input on the day of surgery, and a reliable next-day safety net. (gettingitrightfirsttime.co.uk) The source documents support the pathway elements and default-stay model; the exact local checklist will vary by trust. ### Where does patient information fit? GIRFT’s March 2023 guide says patient education programmes should embed the expectation of early discharge, and the Day Case First pack stresses standardised processes across the pathway. (gettingitrightfirsttime.co.uk) That makes patient information one of the highest-yield operational tools, because it can set expectations before admission and reduce avoidable variation on the ward. A standard pre-operative leaflet or video is consistent with that approach if it covers length of stay, mobilisation, analgesia, wound care, red flags and contact routes. (gettingitrightfirsttime.co.uk) That is an inference from the pathway documents rather than a quoted checklist item, but it matches the guidance’s emphasis on referral-stage planning, multidisciplinary delivery and patient education. ### What should readers watch next? The standing NHS sources for this work are GIRFT’s orthopaedic surgery programme, GIRFT’s day case surgery hub and CPOC’s education and guidance pages. (gettingitrightfirsttime.co.uk) Those are where trusts can find the March 2023 ambulatory arthroplasty guide, the September 2024 Day Case First pack and related implementation resources. (gettingitrightfirsttime.co.uk)