Reduced length of stay (LOS) is logistically, economically and physiologically beneficial. Although a high proportion of total joint arthroplasty (TJA) patients are suitable for same day admission (SDA), removable barriers persist in many centres. This study aimed to determine factors limiting SDA and quantify the impact of implementing both SDA and a targeted enhanced recovery programme on length of stay.

This single-centre retrospective cohort study collected data on elective TJA patients aged <60. Qualitative service reviews identified opportunities for optimisation. Improvements were implemented in 2017, including: obtaining consent at the pre-assessment clinic and robustly assessing suitability for SDA. A targeted rapid recovery program was implemented in June 2018. Data was collected prior to changes in 2017, and following changes in 2018.

106 of 108 screened patients were eligible for inclusion. There were no significant between-year differences in baseline health characteristics. Significantly greater proportions of 2018 patients were consented at their pre-assessment clinic (56% vs 8.9%, p<0.001) and assessed as suitable for SDA (94% vs 57.1%, p<0.001). Pre-operative LOS was significantly reduced in 2018 for both total hip replacements (median [IQR]: 0[0,0] vs 1[1,1], p<0.001) and total knee replacements (median [IQR]: 0[0,0] vs 0[0,1], p=0.002). The departmental mean LOS improved from 4.7 days to 3.7 days following SDA. This was further shortened to 3.2 days after introduction of the rapid recovery program.

When a larger proportion of patients were deemed suitable for SDA, this correlated with reduction of LOS. The department now performs above national standards in both of these parameters.