Abstract
Background
With the recent trend towards enhanced care in joint replacement, it has become increasingly important to identify and address the areas that affect early patient length of stay, while ensuring that practice remains safe. As part of an enhanced care program we conducted two prospective studies of factors delaying discharge following hip replacement in 2006 and 2010.
Materials and Methods
In each limb of the study data was collected prospectively daily, by an independent observer, on 100 consecutive primary cemented total hip replacements. Reasons for delay to the discharge and variation from the patient pathway were identified and addressed.
Results
The mean length of stay in hospital in 2006 was 4.8 days (target for discharge 4 days) and in 2010, 3.6 days (target for discharge 3 days). In 2006, 31 patients had a stay of more than 4 days, 17 due to inadequate physiotherapy provision, 10 for medical and 4 for other reasons. In 2010, 29 patients had a stay of more than 3 days (though only 15 stayed longer than 4 days), only 2 patients had inadequate physiotherapy provision, in 7 cases discharge was delayed because of need for blood transfusion and 11 because of need for catheterisation. Women, aged more than 70 with preoperative Hemoglobin of less than 12 g/dL were at particularly high risk of requiring transfusion (p = 0.0001). Catheterisation was also identified as a factor causing significant increase in length of stay (p = 0.003).
Patients going home in less than 3 days were more likely to have had their operation in the morning. In both studies patients attending the preadmission Joint Group education session were less likely to have a delayed discharge. Discharge was not affected by the type of anesthetic or the experience of the operating surgeon.
Conclusions
Patient length of stay is multifactorial and can be continually reduced by close management of patient expectations and incremental identification and improvements in the care pathway.
Recommendations
Regular review of a hip replacement care pathway can bring about incremental changes that together have a significant impact on reducing length of stay.
