Problem: The predicted global trend of increasing total hip replacement and total knee replacement numbers leads to a direct and growing impact on health care services. Models of care including 'fast-track' mobilisation after total hip replacement and total knee replacement have been reported to reduce length of stay. This has not been verified in rural settings.
Setting: Armidale Rural Referral Hospital.
Key Measures For Improvement: The new post-operative care included early discharge planning with or without Day 0 mobilisation with aims to decrease hospital length of stay without affecting complication rates, compared to the conventional model of care.
Strategies For Change: Consistent communication and planning for early discharge occurred before and throughout admission and Day 0 mobilisation.
Effects Of Change: There was a statistically significantly less median length of stay following implementation of the new post-operative care model (3.24 vs 2.29 days [P < .01]). There was no statistically significant difference in complications or readmissions following the change. Those who were allocated to mobilise on Day 0 had a lesser median length of stay than those who did not (2.40 vs 2.27 days, P = .03).
Lessons Learnt: Our results indicate that the new post-operative care model is safe and feasible for total knee replacement or total hip replacement patients in a rural setting and might reduce length of stay without compromising clinical outcomes.
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