Chesterfield Royal Hospital improves patient flow through enhanced recovery programme
Chesterfield Royal Hospital NHS Foundation Trust has delivered significant improvements in patient flow, bed utilisation and sustainability by embedding an enhanced recovery programme for hip and knee replacement pathways.
The programme was delivered through a locally led project supported by our Total Orthopaedic Solutions (TOS) framework, enabling the trust to implement pathway improvements using existing contractual mechanisms.
Why change was needed:
In 2023, Chesterfield Royal Hospital treated:
- 333 hip replacement patients.
- 228 knee replacement patients.
The average length of stay across these pathways was 4.89 days, placing pressure on bed capacity and operational resources. The trust identified an opportunity to optimise pathways to support faster recovery and earlier discharge, while maintaining patient safety and clinical quality.
How the programme worked:
A multidisciplinary team reviewed the end‑to‑end hip and knee pathways to identify opportunities for improvement and standardisation.
The results:
The enhanced recovery programme delivered measurable improvements across operational, financial and sustainability outcomes:
- Average length of stay reduced from 4.89 days to 2.79 days.
- 529 bed days released, improving patient flow and capacity.
- £169,280 non‑cash releasing efficiency benefit, based on £320 per patient.
- *Carbon reduction of 20 tonnes CO2e, calculated using carbon factor for low intensity inpatient bed day.
- £40,398 of programme costs offset through framework mechanisms.
Patients benefited from earlier discharge and improved recovery experiences, while the trust gained greater flexibility across elective pathways.
Looking ahead:
The trust has now embedded the enhanced recovery approach into standard operating procedures. A multidisciplinary working group meets regularly to monitor performance, review outliers and ensure continuous improvement across hip and knee pathways.
There are ambitions to explore day‑case surgery for suitable patients in the future, building on the foundations established through this programme.
We have embedded and updated the above services and improvements into our standard operating procedures for hip and knee replacement surgery at Chesterfield Royal Hospital.
We have established a multidisciplinary team to continuously monitor our length of stay. This team meets monthly to discuss outlier patients with excessive length of stays and ensure that standards are maintained and improvements are continuously made within the hip and knee pathways.
Our length of stay working group will continue to improve, with ambitions to deliver day case surgery in the future for select patients that meet the criteria.
Mr Jeevan Chandrasenan, Consultant Trauma and Orthopaedic Surgeon, Chesterfield Royal Hospital NHS Foundation Trust
Supporting pathway improvement
This example shows how NHS Supply Chain frameworks can support trusts to implement pathway improvements through locally led projects, using existing contracts and governance arrangements. We work closely with trusts to:
- Support pathway review and optimisation.
- Enable access to solutions through national frameworks.
- Share learning that can be applied in other settings.
Links section
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Sustainable Care Pathways Method and Guidance
Access resources from the Sustainable Healthcare Coalition - methods for appraising models of care and understanding the environmental impacts of new or existing care pathways.