Background: This study aimed to improve institutional value-based patient care processes, provider collaboration, and continuous process improvement mechanisms for primary total hip arthroplasties and total knee arthroplasties through establishment of a perioperative orthopedic surgical home.
Methods: On June 1, 2017, an institutionally sponsored initiative commenced known as the orthopedic surgery and anesthesiology surgical improvement strategy project. A multidisciplinary team consisting of orthopedic surgeons, anesthesiologists, advanced practice providers, nurses, pharmacists, physical therapists, social workers, and hospital administration met regularly to identify areas for improvement in the preoperative, intraoperative, and post-anesthesia care unit, and postoperative phases of care.
Results: Mean hospital length of stay decreased from 2.7 to 2.2 days (P < .001), incidence of discharge to a skilled nursing facility decreased from 24% to 17% (P = .008), and the number of patients receiving physical therapy on the day of surgery increased from 10% to 100% (P < .001). Press-Ganey scores increased from 74.9 to 75.8 (94th percentile), while mean and maximum pain scores, opioid consumption, and hospital readmission rates remained unchanged (lowest P = .29). Annual total hip arthroplasty and total knee arthroplasty surgical volume increased by 11.4%. Decreased hospital length of stay and increased surgical volume yielded a combined annual savings of $2.5 million across the 9 involved orthopedic surgeons.
Conclusion: Through application of perioperative surgical home tools and concepts, key advances included phase of care integration, enhanced data management, decreased length of stay, coordinated perioperative management, increased surgical volume without personnel additions, and more efficient communication and patient care flow across preoperative, intraoperative, and postoperative phases.
Level Of Evidence: III Therapeutic.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.arth.2020.09.003 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The aim of this comparative study was to examine the possible benefits of a dedicated Orthopaedic Trauma Room (DOTR) and in the care of patients with proximal femur fractures. A retrospective study of all orthopaedic cases with a hip fracture from 2020 to 2022 at CHC Montlegia has been undertaken, the group is compared to patients with the same impairment from 2018-2020 admitted to Saint Joseph/Esperance CHC hospitals (before the merge and the existence of a DOTR). The delay between the arrival at the emergency department and transfer to the operating room, as well as the mortality are evaluated.
View Article and Find Full Text PDFThe use of rehabilitation beds following hip fracture leads to an increased length of stay.
Acta Orthop Belg
September 2024
The aim of this paper is to identify if there is a difference in length of stay following hip fractures when using rehabilitation beds. Prospective data was collected on all hip fracture admissions in patients over 50 years from May 2016 to February 2018 from ISD NHS Scotland to identify length of stay. It was found that patients discharged home via rehabilitation wards were less likely to have returned to their own home by 30 days post admission and were also significantly more likely to stay in hospital for 40 days or more when compared to patients discharged directly home.
View Article and Find Full Text PDFTemporal Trends of Fungal Infections in Cirrhotic Patients: A Retrospective Cohort Study 2016-2020.
J Clin Exp Hepatol
December 2024
Stanford University, Palo Alto, CA, United States.
Background: Patients with cirrhosis are susceptible to infections due to abnormalities in humoral and cell-mediated immunity. Fungal infections are associated with delayed diagnosis and high mortality rates, emphasizing the importance of performing fungal cultures and maintaining elevated levels of suspicion in this patient population.
Methods: This retrospective cohort study analyzes cirrhotic patients readmitted with bacterial and fungal infections and investigates outcomes, including in-hospital mortality and hospital resource utilization.
Effect of Whey Protein Supplementation on Postoperative Outcomes After Gynecological Cancer Surgery: A Randomized Controlled Trial.
World J Oncol
February 2025
Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand.
Background: Whey protein's biochemical properties make it an ideal nutritional supplement for patients with cancer, especially in perioperative care. Thus, the present study aims to assess the efficacy of whey protein supplementation (WPS) compared to standard care in enhancing postoperative outcomes for patients undergoing comprehensive surgical staging for gynecological cancer.
Methods: In an open-label, randomized controlled trial conducted at Rajavithi Hospital between November 28, 2023 and July 8, 2024, 61 patients scheduled for comprehensive surgical staging were enrolled.
The effect of renal function on the clinical outcomes and management of patients hospitalized with hyperglycemic crises.
Front Endocrinol (Lausanne)
January 2025
Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Background: The global prevalence of diabetes has been rising rapidly in recent years, leading to an increase in patients experiencing hyperglycemic crises like diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Patients with impaired renal function experience a delay in insulin clearance, complicating the adjustment of insulin dosing and elevating hypoglycemia risk. Accordingly, this study aims to evaluate the impact of renal function on the safety and efficacy of insulin use in patients with isolated DKA or combined DKA/HHS.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!