Impact of Bundled Care on Outcomes Following Elective Primary Total Hip or Total Knee Arthroplasty
| Autor: | Steve Talbert, Ellen Reising, Daleen Penoyer, Laura C Arkin |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
musculoskeletal diseases medicine.medical_specialty Joint replacement Arthroplasty Replacement Hip medicine.medical_treatment 03 medical and health sciences Indirect costs Postoperative Complications 0302 clinical medicine Risk Factors Outcome Assessment Health Care Humans Medicine Orthopedics and Sports Medicine 030212 general & internal medicine Patient participation Arthroplasty Replacement Knee Aged Retrospective Studies Advanced and Specialized Nursing 030222 orthopedics Chi-Square Distribution business.industry Retrospective cohort study Middle Aged Arthroplasty Southeastern United States Treatment Outcome Elective Surgical Procedures Physical therapy Female business Elective Surgical Procedure Chi-squared distribution Patient Care Bundles Patient education |
| Zdroj: | Orthopaedic Nursing. 38:262-269 |
| ISSN: | 0744-6020 |
| DOI: | 10.1097/nor.0000000000000573 |
| Popis: | Background Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. Purpose The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). Methods A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. Results Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. Conclusion Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients. |
| Databáze: | OpenAIRE |
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