Healthcare is under a complex set of pressures both economic and political. Rising costs in medication, advancements in medical technology opening up new possibilities for patients and doctors, but also new expenses, the double demographic challenge of significantly more elderly (80+) and smaller generations to recruit from, austerity measures etc. Hip and knee surgeries are a micro-example of this challenge. Earlier discharge, better collaboration across hospitals, involving family and network and primary healthcare in the home are some of the solutions. However, when implementing new processes in the hospitals, new processes need to be implemented in the patient’s homes as well. Involvement of both patients and their family/network together with home care service and facilities have been under development locally, regionally and in a collaboration between Zealand (DK) and Skåne (SE) regions over a period of three years. Sharing experiences and learning from each other across the Øresund region gave a lift to collaboration, experiences and ability to involve patients, home care facility, the political level and the administration.
In this project the development of clinical procedures by healthcare professionals led to a common platform for rehabilitation offers to citizens. A video with all necessary information to all patients, relatives and professionals was carried out and could be used in hospital and at home before and after surgery. It was an extra information source to support the coaching to self-care programme, called an e-health programme, minimising extra transport to hospital and other healthcare services. An economic aspect is to have patients in an orthopaedic department and at home without unnecessary and expensive visits; patients were followed from before surgery until they were back on track in their rehabilitation.
Based on these experiences and the local projects in five different orthopaedic departments, a level of coaching to self-care has been reached that benefits patients, relatives and healthcare professionals in the best way in the use of time, administration, patient satisfaction and security.
The economic calculation has now reached a level of best time, best intervention, best use of resources/economy, and evidence of no gap between hospital and homecare activities.