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RESEARCH ARTICLE
Contents Vol 48(3)

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 https://orcid.org/0009-0009-8454-2045 A * , Rebekah McGaw https://orcid.org/0000-0001-5931-3333 A and Andrew Hardidge https://orcid.org/0000-0002-1036-9974 B C
+ Author Affiliations
- Author Affiliations

A Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Vic., Australia.

B Department of Orthopaedic Surgery, Austin Health, Melbourne, Vic., Australia.

C Department of Surgery, The University of Melbourne, Melbourne, Vic., Australia.

* Correspondence to: Marisa.Delahunt@austin.org.au

Australian Health Review 48(3) 312-320 https://doi.org/10.1071/AH24011
Submitted: 21 December 2023  Accepted: 21 April 2024  Published: 13 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objectives

Internationally, hip or knee arthroplasty (TJA) with a 1-day hospital length of stay (LOS) is common and demonstrates improved patient and health service outcomes. This study aimed 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 and 47 patients completed the protocol. The mean ± standard deviation (s.d.) of the LOS was 34.7 (± 7.2) h with 41 patients (87%) achieving next-day discharge, the remaining six (13%) discharged on Day 2. Compliance with ERAS was high (96%) with mobilisation within 12 h 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.

Keywords: arthroplasty, Australia, enhanced recovery after surgery, ERAS, hip, knee, length of stay, physiotherapy.

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