Abstract
Introduction
The Rapid Recovery Program (RRP) is a holistic perioperative accelerated discharge process that aims to improve efficiency and quality of care, improve patient education, standardise protocols and pathways and encourage early mobilisation & discharge.
Aims
To compare length of stay (LOS) of primary knee arthroplasty patients before and after implementation of the RRP.
Method
A retrospective cohort study of all patients admitted for knee arthroplasty was performed between 1st May 2007 and 28th February 2009. Data were obtained from hospital computer records. LOS of 2 groups compared: Pre-RRP implementation (Pre-RRP) and post-RRP implementation (post-RRP) and analysed using Welch's t- and chi square tests with significant at the p<0.05 level. (Definitions: Day of operation = ‘day 0’, first post-operative day = ‘day 1’, discharge = to the patient's own home).
Results
315 patients identified: 147 Pre-RRP (mean age 72 years; range 48-90) and 168 post-RRP (mean age 71 years; range 38-98).
Mean LOS was reduced from 8.5 days (range 2-30) Pre-RRP to 5.9 days (range 2-38) post-RRP (p<0.01). Median LOS was reduced from 6 days (Pre-RRP) to 4 days (post-RRP) (p<0.01).
Following RRP implementation, more patients were discharged on day 3 (Pre-RRP 9% vs Post RRP 30%; p<0.001) and less patients stayed more than 5 days (Pre-RRP 60% vs Post RRP 34%; p<0.001).
Conclusion
The Rapid Recovery Programme significantly reduced LOS for knee arthroplasty patients, by a mean of 2.6 days. Significantly more patients were discharged by day 3 and significantly less stayed longer than 5 days. As well as cost savings, the patient experience was enhanced and the multidisciplinary team moral increased through centralised team work. Further evaluation of patient outcomes such as complication rates and patient satisfaction must be evaluated.
