My name is Roxana; I am a Registered Nurse specializing in recovery after surgery. I have been involved with the same-day-discharge program at White Rock Orthopaedic Surgery Centre since we started this in 2016. This program has allowed many patients to leave the hospital the same day that surgery was done. At the time that this was initiated, the thought was that this could possibly reduce the risk of infection and other hospital related problems. Now, some nine years later, it has been well established that avoiding hospital stay indeed reduces the incidence of virtually any and all complications. As a patient, this is very important of course, and it re-enforces the notion that a hospital is a place to only utilize if absolutely necessary. Many, many patients have come through this program. We have found that providing support, by facilitating the discharge process from the facility, accompanying the patient home, settling the patient in for the evening, with medication, cooling unit, assessment of ease of access to bed, washroom etc, alleviates anxiety and burden felt by patients and caregivers alike.

Patients have ready access to the nurse and the surgeon after they arrive at home, they can text or call, send pictures, with the team ready to come to the home as needed. We have found over the years that the need for a visit later in the evening is extremely rare, patients are confident and comfortable. The nurse typically attends to the patient once or twice a day at home for two or three days; patients then indicate that they really do not need any further support. At times, another visit is made to assess issues related to the dressing or similar.

Being a nurse in a well-running contemporary outpatient joint replacement program has been incredibly rewarding. We have well moved past the days of patients spending nights in a hospital bed after having their hip or knee replaced. Seeing a patient stand up, walk, and confidently head home just hours after a total hip or knee replacement is a testament to the attention to detail by the surgical team, with emphasis on avoidance of narcotics, application of local anaesthetic, nerve blocks, in our setting mainly placed intra-operatively by the surgeon, techniques to minimize blood loss while avoiding the use of a tourniquet, and so on. My role as a nurse is to bridge the gap between the operating room and the front door, and beyond, ensuring patients have the education regarding the expected course of recovery, patients understand and embrace the pain management plan, have the mobility and support to recover in the comfort of their own home. There’s no better 'thank you' than watching a patient realize they don't need a long hospital stay to start their journey back to an active life.

Over the years we have received many letters of appreciation, too many to post. Some excerpts:

Ms. T.A.:

I am writing to commend Dr. Smit and the peri-operative staff…for the excellent care for both of my TKR’s, one back in 2018 and the second one in February of this year. Being allowed to have this as day-surgery was such a great benefit…. So may fewer risk factors as afar as infections etc. Having an R.N. visit me at home for the first 3 days, as well as being on call was also very re-assuring.

Ms. B.A.:

In 2023 I underwent full knee replacement at Peace Arch Hospital under the care of Dr. Arno Smit. I was discharged the day of the surgery into the care of a registered nurse who assisted me into my home and closely monitored my recovery. Because my experience has been so extremely positive, I want to do anything I can to ensure this opportunity is supported and is easily accessible to anyone able to make the choice for day surgery for knee replacement. This is my second knee replacement, both performed by Dr. Smit and both as day-surgery procedures. With Dr. Smit's continued approach of "Patient care first", my recovery time for each surgery, particularly for a 73-year-old woman, has been nothing less than phenomenal. I attribute this to being in the comfort of my own home, access to fresh air, much less exposure to harmful germs, particularly given our COVID and super bug times and in the company of supportive family and friends. I was also able to get the much-needed rest required without the normal noise of a busy hospital. I had immediate access (5 - 10 minutes maximum) to a highly qualified nurse (who was in contact with Dr. Smit for any more serious concerns). Any anxiety created by the multitude of questions patients typically have after such major surgery, was virtually eliminated by the immediate (by text) response of my nurse, thus helping to keep me mentally strong. Research is extensive on the common experience of post-operative surgical depression. Because of my treatment by Dr. Smit as well as his amazing nurse and even his excellent office staff, while I am prone to mood swings, I barely had a low day following my surgeries. 

Because I was in my home within hours after my surgery, my sense of independence and control of my health was incredibly much higher than if I had stayed in the hospital, even for one day. As mentioned, research supports the premise that recovery is enhanced with good mental health. Being exposed to loud noise, and as in my last hospital visit, coughing, fellow patients a few feet away, does little to create comfort or keep a person thinking positively. This is not a complaint - simply the reality of hospital life for a person who is "well" other than having a non-functioning (temporarily) knee. With the very quick and easy access to medical support such as provided to me throughout my surgeries by Dr. Smit, I simply cannot see any risk today of surgery discharge for knee replacements.

Ms. K.D.:

My husband received a full knee replacement by Dr. Smit. At our age we are trying to live our best life and the same day discharge was wonderful from start to finish. We had great care; my husband was thrilled and as a result his recovery was swift both physically and mentally which is so important. So, ladies and gentlemen and all Doctors, continue to be pioneers for all of us that are counting on forward thinking individuals to move medicine into the future with positive surgical experiences such as this. 

Mr. D.G.:

I underwent Total Hip Replacement surgery by Dr. Smit. I was discharged the same day as my surgery. After discharge, Dr. Smit's support staff followed me home, set me and my wife up for home recovery procedures and conducted thorough subsequent visits over the following several days. I was very fortunate to have Dr. Smit do my surgery. I was also fortunate to have been discharged the same day and begin recovery in my own home. I had a very positive experience through my surgery, Post Op and throughout my Recovery process. I would recommend a Same Day Discharge Program for anyone who has the same type of surgery as I did and has similar physical capabilities. 

Mr. R.I.:

I am writing to commend Dr. Smit and the supported same-day-discharge system I experienced when I underwent a right knee replacement. I had a morning surgery that apparently went very well, and I felt that going home the same day had multiple benefits for me including having the comfort of my own home, a reduced chance of infection, far less swelling, and a very positive beginning to my first few days of recovery. This experience is in stark contrast to my experience 16 years earlier when I had a left knee replacement for which I stayed for two additional days in hospital at the UBC knee and hip surgery centre. At that time, I was exposed to an influenza virus (likely from sharing a washroom with another patient) during the first few days of recovery. This resulted in a very difficult start, caused by a significant fever from my illness and resulting in two trips to the Hospital Emergency for diagnosis and treatment. I think it is likely that I would not have contracted this infection had I been recovering at home like this time. I realize that going home involved me having a nurse for the first few days after surgery and I think this feature was a key to my successful experience this time. I was set up in my home, on one level, with an ensuite bathroom and equipment (from the Red Cross) to ensure safety. The nurse was amazing, setting up my medications, instructing me on using a cooling machine (on loan), checking my vitals, testing my blood, checking my incision dressing and helping me with my initial walking with a walker. During this time, she was very positive and supportive as well as available by text anytime if I needed assistance or had questions. At this point I am over two weeks into my recovery, and I am fairly independent with the aid only of my wife. I feel that this program offered so much for me during my initial recovery and made me feel so much better about the process. I would recommend this discharge option to any suitable patient who has suitable living space and some support at home.

Mr. A.J.:

Dr. Smit performed left hip replacement surgery in January 2023. The surgery was performed under Dr. Smit’s same-day-discharge program with out-patient nurse support, provided by his office, following the surgery. Dr. Smit previously performed a right hip replacement surgery for me several years ago at UBC Hospital under the more traditional stay-at-hospital model following surgery. Advantages of the same day discharge program included that I was able to recover at home- more comfortable and with less cost incurred by the provincial health system. Outpatient nursing care was carried out in an efficient and effective manner. I would definitely recommend the same day discharge program for those individuals who have adequate home support and appropriate physiotherapy treatment. 

Ms. S.P.:

In 2018 I had a complete knee replacement in Dr. A. Smit's operating room at White Rock Orthopaedic Surgery Centre. I can't begin to tell you how much easier and more relaxing this was as a patient. I arrived at around 9 am was on the table by 10:30 and went home at 4 pm. I was accompanied by my daughter and a nurse. I had a nurse come into my house for the next two days. I really believe that my surgery was made easier for me and my family because of the lack of stress. I think using existing private facilities can help alleviate wait times. I am needing my other knee replaced but am waiting for much too long. I am a great believer in a public system, but it has to be flexible when times are tough which they are now. 

Mr. G.T.:

In February 2023 Dr Smit replaced my right knee. The surgery was done in hospital and by late afternoon my wife was able to pick me up and take me back to our accommodation. As we recently moved to the Interior, some 5 hours away from White Rock, we were staying at a nearby hotel. Roxana, the nurse, was at the hospital with me and then followed us back to the hotel. She spent a lot of time going over what to expect for the first few days and told us all about the medication I would be taking. Roxana took the time to talk to both my wife and I to get to know us. She was back first thing the next morning to check on me. She came to see me daily, including the fourth day when we had moved to my mother’s place for a few days. All of the check ups with Roxana were professional, fun and relaxed. I have never had to stay in the hospital before and was not looking forward to it with my knee surgery. This option of having a nurse come to me was the perfect solution. It was so nice to be in my own space and a comfortable bed. My wife was able to keep my ice machine full at all times. And I was able to eat what I wanted, when I was hungry. Another great benefit was that my nurse support did not end after the first few days. Roxana gave us her cell number and told us to text her at any time with any questions. She wanted to know how our trip back home was and wanted me to check in many times after I was home to make sure everything was going well and that I was doing everything that Dr. Smit had prescribed. I am very happy with the job that Dr. Smit did with my surgery and follow up. I definitely felt that I was well looked after, and my knee and scar are healing perfectly! As my second knee surgery is approaching, it was wonderful to get a text from Roxana to say that she will be my nurse support again. This makes one less thing to be concerned about with my surgery. I highly recommend this strategy for any surgery that doesn't fully require a hospital stay.

Ms. P.T.:

I was a participant in the Same Day Discharge program, twice. My experience was excellent for both. Knee replacement surgery & the opportunity to return home the same day worked well for me. My care from Dr Smit & his staff was commendable. Daily visits for 3 days from the nurse was sufficient for post surgery care. Subsequent post care included provision of Cryogenic cold therapy equipment, wound inspection & thorough examination of the incision & progress of my mobility. I also participated in 12 physiotherapy sessions. These sessions encouraged movement & enhanced recovery. It has been almost 9 years since the first surgery & 7 years since the second. I am grateful that both have allowed me to enjoy an active life. I can only hope others are offered this opportunity. It is a cost-efficient program that would relieve some of the burden on our Health Care system. Most importantly, this program would reduce wait times for people suffering from pain & discomfort. 

Mr. B.Y.:

I am writing to express my gratitude for providing the option of a "Same Day Discharge Program" following my knee replacement surgery in 2023. I was able to check into the hospital first thing in the morning for surgery and was back at home by dinner time the same day. My experience with this program was a very positive one, both physically and mentally and I'm quite certain it led to a speedier recovery. Being in my own home following my surgery was very comforting and I especially appreciated having nurse Roxana tend to my needs in such an attentive, caring and professional manner. Roxana was able to monitor the surgical area, administer medications and monitor my vitals. She was also available anytime for communication during the first few days. I think this is a wonderful program and would highly recommend it to anyone. 

Ms. M.V.:

I had two total knee replacements in the same year. On both occasions I went home on the same day. There are advantages to same day discharges: I was much more prepared for my recovery and did better planning that I may have done if I had not gone home the same day. Somehow knowing that you are coming home right away makes a person more diligent in ensuring that you have thought of everything you may need, including supports at home. I know what germs thrive and grow in our hospitals; I feel I have a better chance of no post surgery infection or other hospital-acquired infections if I come straight home. The hospitals are busy and even the part day I spent in the ward was enough to convince me that I would receive better personal care at home. (I differentiate between clinical and personal care, clinical care being vitals, wound care, IV lines, medications etc. personal care means helping me to the toilet when I need to go, helping me wash my face or brush my teeth, bringing me a glass of water.) There are some things that are important for same day discharges to succeed: pre-op teaching of patients and families to prepare, good pain management, a check in call from a nurse on day 1, 2 and possibly 3. In my opinion, as long as there are no other medical or psychosocial reasons that someone cannot go home same day, all hip and knee replacements should be given the option to go home the same day.