PURPOSE: The aim of this study was to examine the effect of an integrated care pathway (ICP) for total hip and knee arthroplasty (THA/TKA) on length of stay (LOS), day of surgery admission rate (DOSA) and postoperative length of stay (POLOS). METHODS: Three hundred and eight THAs and 299 TKAs were assessed in a retrospective before-after trial design. LOS, POLOS and DOSA were recorded for patients before and after introduction of the ICP. The ICP encompassed a patient education programme, specific daily management goals, variance mapping, daily facilitated meetings and a DOSA policy. Subgroup analysis according to age and gender was also performed. RESULTS: Mean LOS was significantly reduced by 1.4 (from 6.9 to 5.5) days for THA and 0.8 (from 6.4 to 5.6) days for TKA. Elderly patients and men achieved greater LOS reductions than their counterparts for both operations. Younger patients undergoing THA achieved a significantly higher DOSA rate than older patients (89 % vs 71 %, p = 0.010); however, this difference was not observed in the TKA population. Mean POLOS for THA was reduced by 0.6 (from 5.9 to 5.3) days, again with the greatest benefit seen in elderly and male patients. POLOS for TKA patients was not significantly affected by the ICP. CONCLUSIONS: The introduction of an ICP reduced LOS by 1.4 days for THA and 0.8 days for TKA. Elderly and male patients benefitted most.
PURPOSE: The aim of this study was to examine the effect of an integrated care pathway (ICP) for total hip and knee arthroplasty (THA/TKA) on length of stay (LOS), day of surgery admission rate (DOSA) and postoperative length of stay (POLOS). METHODS: Three hundred and eight THAs and 299 TKAs were assessed in a retrospective before-after trial design. LOS, POLOS and DOSA were recorded for patients before and after introduction of the ICP. The ICP encompassed a patient education programme, specific daily management goals, variance mapping, daily facilitated meetings and a DOSA policy. Subgroup analysis according to age and gender was also performed. RESULTS: Mean LOS was significantly reduced by 1.4 (from 6.9 to 5.5) days for THA and 0.8 (from 6.4 to 5.6) days for TKA. Elderly patients and men achieved greater LOS reductions than their counterparts for both operations. Younger patients undergoing THA achieved a significantly higher DOSA rate than older patients (89 % vs 71 %, p = 0.010); however, this difference was not observed in the TKA population. Mean POLOS for THA was reduced by 0.6 (from 5.9 to 5.3) days, again with the greatest benefit seen in elderly and male patients. POLOS for TKA patients was not significantly affected by the ICP. CONCLUSIONS: The introduction of an ICP reduced LOS by 1.4 days for THA and 0.8 days for TKA. Elderly and male patients benefitted most.
Authors: Sydney Morss Dy; Pushkal P Garg; Dorothy Nyberg; Patricia B Dawson; Peter J Pronovost; Laura Morlock; Haya R Rubin; Marie Diener-West; Albert W Wu Journal: Med Care Date: 2003-05 Impact factor: 2.983
Authors: Velandai K Srikanth; Jayne L Fryer; Guangju Zhai; Tania M Winzenberg; David Hosmer; Graeme Jones Journal: Osteoarthritis Cartilage Date: 2005-09 Impact factor: 6.576
Authors: Daniëlle E Brunenberg; Mike J van Steyn; Judith C Sluimer; Linda L Bekebrede; Sjoerd K Bulstra; Manuela A Joore Journal: Med Care Date: 2005-10 Impact factor: 2.983
Authors: M Elaine Husni; Elena Losina; Anne H Fossel; Daniel H Solomon; Nizar N Mahomed; Jeffrey N Katz Journal: BMC Musculoskelet Disord Date: 2010-07-14 Impact factor: 2.362
Authors: Andrea L Cheville; Lori Rhudy; Jeffrey R Basford; Joan M Griffin; Ann Marie Flores Journal: Arch Phys Med Rehabil Date: 2016-08-31 Impact factor: 3.966
Authors: Matthew Glover; Erin Montague; Alexandra Pollitt; Susan Guthrie; Stephen Hanney; Martin Buxton; Jonathan Grant Journal: Health Res Policy Syst Date: 2018-01-10
Authors: Marcel Mayer; Justine Naylor; Ian Harris; Helen Badge; Sam Adie; Kathryn Mills; Joseph Descallar Journal: PLoS One Date: 2017-07-19 Impact factor: 3.240