Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
Shopping Cart: ( empty )
You are here: Home > Journals > AH > AH24011
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.

References

1  Petersen PB, Jørgensen CC, Kehlet H, Lundbeck Foundation Center for Fast-track Hip and Knee Replacement collaborative group. Temporal trends in length of stay and readmissions after fast-track hip and knee arthroplasty. Dan Med J 2019; 66: A5553.
| Google Scholar | PubMed |

2  Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop 2020; 91: 3-19.
| Crossref | Google Scholar | PubMed |

3  Wainwright TW. Enhanced recovery after surgery (ERAS) for hip and knee replacement—why and how it should be implemented following the COVID-19 pandemic. Medicina 2021; 57: 81.
| Crossref | Google Scholar | PubMed |

4  Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2021 Annual Report. Adelaide: AOA; 2021.

5  Ackerman IN, Bohensky MA, Zomer E, Tacey M, Gorelik A, Brand CA, de Steiger R. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 2019; 20: 90.
| Crossref | Google Scholar | PubMed |

6  Pietrzak JRT, Maharaj Z, Erasmus M, Sikhauli N, Cakic JN, Mokete L. Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic. World J Orthop 2021; 12: 152.
| Crossref | Google Scholar | PubMed |

7  Gill S, Graves S, Lorimer M, de Steiger R, Ackerman I, Ellis A, Page R. COVID‐19 impact on joint replacement surgery in Australia in 2020: a nationwide perspective. ANZ J Surg 2022; 92: 10.
| Crossref | Google Scholar | PubMed |

8  Australian Institute of Health and Welfare. Chronic musculoskeletal conditions hospitals data tables 2023. Musculoskeletal hospitalisation statistics, Australia. Canberra: Australian Institute of Health and Welfare; 2023. Available at https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-musculoskeletal-conditions/data

9  Memtsoudis SG, Fiasconaro M, Soffin EM, Liu J, Wilson LA, Poeran J, et al. Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study. Br J Anaesth 2020; 124: 638-47.
| Crossref | Google Scholar | PubMed |

10  Andreasen SE, Holm HB, Jørgensen M, Gromov K, Kjærsgaard-Andersen P, Husted H. Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty. J Arthroplasty 2017; 32: 1747-55.
| Crossref | Google Scholar | PubMed |

11  Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-7.
| Crossref | Google Scholar | PubMed |

12  Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A framework for safe, reliable, and effective care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017.

13  Australian Commission on Safety and Quality in Health Care. Australian Hospital Patient Experience Question Set: Australian Commission on Safety and Quality in Health Care. 2019. Available at https://www.safetyandquality.gov.au/our-work/indicators-measurement-and-reporting/australian-hospital-patient-experience-question-set

14  Qurashi S, Chinnappa J, Aktas S, Dabboussi AM, Rahman MB. Overnight joint replacement surgery: a pilot Australian study. ANZ J Surg 2022; 92: 2683-7.
| Crossref | Google Scholar | PubMed |

15  Nassar I, Fahey J, Mitchell D. Rapid recovery following hip and knee arthroplasty using local infiltration analgesia: length of stay, rehabilitation protocol and cost savings. ANZ J Surg 2020; 90: 355-9.
| Crossref | Google Scholar | PubMed |

16  Petersen PB, Kehlet H, Jørgensen CC. Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017. Sci Rep 2020; 10: 21233.
| Crossref | Google Scholar |

17  Morrell AT, Layon DR, Scott MJ, Kates SL, Golladay GJ, Patel NK. Enhanced recovery after primary total hip and knee arthroplasty: a systematic review. J Bone Joint Surg Am 2021; 103: 1938-47.
| Crossref | Google Scholar | PubMed |

18  Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, Sánchez-Martín R, et al. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA Surg 2020; 155: e196024.
| Crossref | Google Scholar |

19  Gwynne-Jones DP, Martin G, Crane C. Enhanced recovery after surgery for hip and knee replacements. Orthop Nurs 2017; 36: 203-10.
| Crossref | Google Scholar | PubMed |

20  Tan NLT, Hunt JL, Gwini SM. Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: a quality improvement study. BMC Anesthesiol 2018; 18: 64.
| Crossref | Google Scholar |

21  Scholes C, Cowley M, Ebrahimi M, Genon M, Martin SJ. Factors affecting hospital length of stay following total knee replacement: a retrospective analysis in a Regional Hospital. J Knee Surg 34: 552-60.
| Crossref | Google Scholar | PubMed |

22  Fatima M, Scholes CJ, Tutty A, Ebrahimi M, Genon M, Martin SJ. Patient-reported outcomes of a short hospital stay after total knee replacement in a regional public hospital: a prospective cohort treated 2018–2019. ANZ J Surg 2022; 92: 837-42.
| Crossref | Google Scholar | PubMed |

23  Gautreau S, Haley R, Gould ON, Canales DD, Mann T, Forsythe ME. Predictors of farther mobilization on day of surgery and shorter length of stay after total joint arthroplasty. Can J Surg 2020; 63: E509-16.
| Crossref | Google Scholar | PubMed |

24  Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. J Comp Eff Res 2021; 11: 121-9.
| Crossref | Google Scholar |

25  Coles E, Anderson J, Maxwell M, Harris FM, Gray NM, Milner G, MacGillivray S. The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Syst Rev 2020; 9: 94.
| Crossref | Google Scholar | PubMed |

26  Wainwright TW. The Quality Improvement Challenge-How Nurses and Allied Health Professionals Can Solve the Knowing-Doing Gap in Enhanced Recovery after Surgery (ERAS). Medicina 2020; 56:.
| Crossref | Google Scholar | PubMed |

27  Specht K, Kjaersgaard-Andersen P, Kehlet H, Pedersen BD. Nursing in fast-track total hip and knee arthroplasty: A retrospective study. Int J Orthop Trauma Nurs 2015; 19: 121-30.
| Crossref | Google Scholar | PubMed |

28  Schmucker AM, Hupert N, Mandl LA. The Impact of Frailty on Short-Term Outcomes After Elective Hip and Knee Arthroplasty in Older Adults: A Systematic Review. Geriatr Orthop Surg Rehabil 2019; 10: 2151459319835109.
| Crossref | Google Scholar | PubMed |