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A pilot model of care to achieve next-day discharge in patients undergoing hip and knee arthroplasty in an Australian public hospital setting.

Marisa Delahunt , Rebekah McGaw, Andrew Hardidge

Abstract

Background: Internationally, hip or knee arthroplasty (TJA) with a one-day hospital length of stay (LOS) is common and demonstrates improved patient and health service outcomes. The aim of this study was to develop and pilot an Enhanced Recovery Program (ERP) for patients undergoing TJA to achieve a next-day discharge in an Australian public hospital setting. Methods: A project lead and six perioperative clinical craft group leads developed an ERP protocol based on Enhanced Recovery After Surgery (ERAS) principles. Strict patient eligibility criteria were developed. Quality improvement methodology was used to implement the ERP. A patient navigator was put in place as a single contact point for patients. Results: A total of 825 patients were screened for the ERP (Figure 1) Forty-seven patients completed the ERP. Mean ± standard deviation (SD) LOS was 34.7(±7.2) hours with 41 patients (87%) achieving next-day discharge, the remaining six (13%) discharged on day two. Compliance with ERAS was high (96%) with mobilisation within 12 hours occurring on 87% of occasions. There were no adverse events. Patient experience was positive. Conclusion: Next-day discharge was achieved with a selected cohort of patients with no adverse events and positive patient experience, using a multidisciplinary approach and an improvement framework. Broadening inclusion criteria will make ERP available to more patients.

AH24011  Accepted 21 April 2024

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