Total knee arthroplasty (TKA) is considered as one of the most successful and cost-effective medical interventions yet it is consistently reported that up to 20% of patients are dissatisfied with their outcomes. Patient satisfaction is correlated with the fulfillment of expectations and an important aspect of this involves good surgeon-patient communication, which itself is a contributor to TKA satisfaction. The purpose of this study was to develop and test a checklist intended to enhance the quality of surgeon-patient communication by optimizing the surgeon's role in helping patients set (or reset) and manage post-TKA expectations that are realistic, achievable, and most importantly, patient-specific. In this prospective mixed methods study, a communication checklist was developed from the analysis of interviews with patients who were between six weeks and six months post-TKA. Four orthopaedic surgeons then used the checklist to guide discussions with patients about post-operative expectations and outcomes during follow-up visits between six weeks and six months. A visual analogue scale was used to survey two groups of patients on five measures of satisfaction: the standard of care communication group and the intervention group who had received the checklist. The mean scores of the two groups were compared using independent t-tests. The duration of follow-up visits was also tracked to determine if the checklist took significantly more time in practice. Themes from the qualitative analysis of eight patient interviews incorporated into the checklist included pain management, medication, physiotherapy, and general concerns and questions. The quantitative study comprised 127 participants, 67 in the standard of care communication group and 60 in the checklist group. There were no significant group differences in gender, BMI, comorbidities, post-operative complications, marital or occupational status, however the standard of care group was older by six years (p < .001). The checklist group reported significantly greater satisfaction on four of the five measures of satisfaction: TKA satisfaction and expectations met (p = .017), care and concern shown by the surgeons (p = .011), surgeons' communication ability (p = .008), and satisfaction with time surgeons spent with patients during follow-up visits (p < .001). Satisfaction with the TKA for relieving pain and restoring function was not significant (p = .064). Although the checklist increased the average clinic visit time by only 1 minute, 51 seconds, it was significantly greater (p = .001). The impact of age and gender on satisfaction was explored using a two-way analysis of variance. No significant effects or interactions were observed. Checklists have been shown to decrease medical errors and improve overall standards of patient care but no published research to date has used a communication checklist to enhance orthopaedic surgeon-patient communication. The present findings indicate that this simple tool can significantly increase patient satisfaction. This has practical significance because patient satisfaction is a metric that is increasingly used as a key performance indicator for surgeons and health care institutions alike. Increased TKA satisfaction will benefit patients, surgeons, and the health care system overall.
An enhanced recovery programme for knee arthroplasty was introduced two years ago to our orthopaedic department. It involved the setting up of an educational programme for patients along with an extensive rehabilitation programme. The main aim of the programme is to provide an efficient and personalised service that results in an improved patient experience and fewer bed days following surgery. We carried out a retrospective study, randomly selecting 100 patients over a period of a year who were enrolled in the enhanced recovery programme. We analysed three main areas involving the pre-, peri- and post-operative period. We looked for any key factors that led to an increase or decrease in bed days. The re-admissions were analysed and the cost benefit was calculated. 99 patients were randomly selected and satisfied the inclusion criteria. We found that with the enhanced recovery programme the average length of stay for a knee arthroplasty was four days. There were no re-admissions within the population. We would like to share our enhanced recovery programme model as we feel it is a robust and effective way of providing a high level of care and decreasing the length of stay post-operatively.
