Preoperative and postoperative management: the role of allied health professionals.

The success of a coordinated team approach is dependent upon respect and communication among all members, all directed toward the individual patient's goal. Standardized forms can be developed by each discipline and used as a formal mode of communication. These can be available in each patient's record for all the professional staff to read. Unitization has established an atomosphere for informal ongoing communication: i.e. allied health team members have been assigned to the same patient care unit. The same allied health members are therefore working together with the same patient on a day by day basis. Greater efficiency and communication tend to develop spontaneously within such a system. Full inpatient coverage seven days a week by the therapist as well as the nurses has improved continuity of care. Since these changes in staff distribution have taken place, a study of a significant number of patients undergoin total knee or toal hip procedures has shown that there has been a reduction in the average length of stay for the hospitalization, from two days for a total knee replacement to five days for a patient undergoing total hip replacement. Weekly or twice weekly meetings of allied health members, surgeons, and rheumatologists greatly facilitate the progression and coorination of the treatment program. Medical and nursing audits on patients with total hip procedures document a remarkably low rate of surgical complications. Early discharge planning has fostered a smooth transition of the patient to his home and ultimately to work.