The Rapid Recovery Joint Program is optimising efficient and effective joint replacement recovery pathways in Mid North Coast Local Health District (MNCLHD), enabling same-day discharge for eligible patients.
Led by MNCLHD and piloted at the Coffs Harbour Health Campus, this program began in 2024 to enhance patient outcomes and streamline care pathways for joint replacement surgeries, through a collaborative and multidisciplinary approach. The program places patients at the centre of care, focusing on education, comfort, confidence and participation.
A collaborative approach by surgical, anaesthetics, nursing, physiotherapy and Osteoarthritis Chronic Care Program (OACCP) teams provides patients with consistent information, clear expectations and reinforces their role in their own successful recovery.
The initiative delivers:
- improved patient experience through recovery at home
- reduced length of stay and increased surgical throughput
- cost-efficiency through avoided bed days
- better alignment with NSW Health policy for joint replacement optimisation and day-surgery models.
A patient-centred recovery approach
The Rapid Recovery Joint Program optimises patients preoperatively in collaboration with OACCPs, identifying those suitable for a day-only surgery model.
Key features of the program include:
- anaesthetic strategies that support early mobilisation and reduce postoperative complication risk
- a same-day discharge to Hospital in the Home (HITH) services where recovery is supported in the comfort of home
- tailored follow-up from nurses and physiotherapists to provide oversight and reassurance
- continuous debriefing processes to refine care following each early case.
Clinicians identify appropriate candidates preoperatively, supported by prehabilitation strategies delivered through the newly-named Knee and Hip Osteoarthritis Program (KHOP), previously known as an OACCP. Preparation includes strength and mobility conditioning, pain and anxiety management and building support networks at home.
Clinicians identify suitable candidates for the program, which includes tailored anaesthetic techniques that minimise risks such as pain, infection and blood clots. These strategies enable same-day discharge, allowing recovery at home.
Patients recovering at home benefit from their family’s presence, home-cooked meals and familiar routines, contributing to a positive recovery experience. Postoperative care is seamlessly managed by HITH services, with nurses and physiotherapists providing follow-up care. This continuity minimises readmission risks and empowers patients throughout their recovery journey.
Local governance supported by system-level leadership
To support implementation of the program, each of our participating hospitals established a local governance framework underpinned by the following:
- a multidisciplinary working group that met regularly to progress actions and resolve barriers.
- improved communication and collaboration with our clinical leads.
- further offering from a local surgeon to participate in direct referrals of total knee replacement to support management of waitlist volumes.
The backing of the Agency for Clinical Innovation and the Ministry of Health was pivotal. Their leadership and investment gave weight to site-level conversations, providing levers for change that might not have had the same traction without this external sponsorship. The authority and support behind the initiative, built confidence across teams and created the conditions for success.
Clinical leadership from surgeons at both Coffs Harbour and Port Macquarie has underpinned confidence in early adoption, with broader uptake accelerating as the safety and outcomes of early cases were demonstrated. Experience from international rapid-recovery models among key contributors has also enabled team confidence and supported change readiness.
The program aligns with osteoarthritis clinical care standards through conservative management, education and optimisation for surgery. The program continues to play an important enabling role for rapid recovery participants, and ongoing work is focused on strengthening integration and capacity over time.
14 patients successfully discharged on day zero
The program has demonstrated significant improvements in productivity, efficiency and value for money. By reducing length of stay and enabling safe same-day discharge for appropriate patients, the program increases available bed capacity to meet rising surgical demand while maintaining high-quality care.
At Coffs Harbour Health Campus, 13 patients have been successfully discharged on day zero since May 2024 – including 11 total knee replacements and 2 total hip replacements. At Port Macquarie Hospital, there have been 2 successful same-day discharges, including 1 total knee replacement and 1 total hip replacement. Some patients not participating in preventative programs have been identified as able to return home under the care of the Orthopaedic teams and HITH services. They are not captured in our day zeros; however, some have been discharged within 28hrs from admission.
These outcomes highlight the program’s focus on empowering patients, preparing them preoperatively and supporting their recovery goals through coordinated care pathways. We have now expanded the program to Port Macquarie Base Hospital, where the first successful day-zero joint replacement patient was recently discharged.
The program has demonstrated a broader cultural shift in patient-centred care. Teams now consistently support earlier mobilisation and appropriately planned discharge for suitable patients, contributing to reduced length of stay and improved patient flow. Education, prehabilitation and shared post-operative goals strengthen trust and confidence, supporting positive recovery experiences and high patient satisfaction.
While results to date have been strong, the number of suitable candidates available to progress through the model has also been influenced by system priorities. Our healthiest and most optimised patients - those most suitable for same-day discharge - are frequently supported through collaborative care arrangements with private providers to address statewide waitlist pressures. Despite this, MNCLHD teams have continued to identify, prepare and deliver successful day-zero outcomes, demonstrating the robustness of the pathway and its readiness for scale when more of these patients are able to access the public service.
The program is now expanding across MNCLHD, with sustained collaboration ensuring continuous refinement and scale to additional surgeons and sites. Planned work for 2026 includes:
- extending eligibility to more patients and additional surgeons
- embedding KHOP preparation as a standard preoperative requirement
- progressing HITH capability to further increase same-day discharge
- standardising governance to support scale across the district.
