Shortening Pre-op Length of Stay for Total Knee Replacement by Well-Coordinated Integrated Arrangement and Group Education Class

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Abstract Summary
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Authors (including presenting author) :
LC Leung(1), WY Leung(1), WY Lai(1), CM Chan(1), YN Li(1), KT Tam(1), FP Hui(4), CM Ma(1), CY Mak(1),CY Mok(1), WK Sum(1), SS Hui(1), KL Yuen(3), WY Wong(2), TK Cheung (2)
Affiliation :
(1)Orthopaedic and Traumatology Department, (2)Physiotherapy Department, (3)Occupational Therapy Department, (4)Day Rehabilitation Centre
Introduction :
Total joint replacement is a highly effective treatment for end-stages joint arthritis. Regrettably, this has been demonstrating an increasing demand on the public medical system in Hong Kong and the queue for total knee replacement (TKR) in our hospital is up to 7 years. In the past, workflow for TKR preparation in our hospital was fragmented and also practice varied in different surgeons. The fragmented workflow not only tormented the patients but also produced unnecessary wastage of resource e.g. admission one day before operation. Therefore, a multidisciplinary workgroup worked together to review the system, reformed the procedure and streamlined the workflow.
Objectives :
1. Enhance effectiveness of pre-operative preparation for TKR through streamlining the pre-op workup process. 2. Reduce pre-op length of stay (LOS) for TKR through provision of standardized education class and expectation management.
Methodology :
1. Liaison with different departments, the usual practice on pre-op checkup was reviewed and reorganized. 2. Monthly Pre-Operation Knee Class (POKC) was executed to provide education and assessment. 3. Exclusion criteria were set for non-same day admission. 4. Nurse performed phone reminder to ensure the readiness of same day admission. 5. Data collected for comparison of before and after implementation.
Result & Outcome :
Before implementation (Jul-Dec 2017): 55 patients had undergone TKR. The total pre-op LOS was 67 days, average pre-op LOS was 1.2 days per person. After implementation (Jul-Dec 2018): 67 patients had undergone TKR. The total pre-op LOS was 42 days, average pre-op LOS was 0.6 days per person. Totally 55 patients attended POKC. The result showed that we had significantly decreased 50% of pre-op bed occupancy days. In conclusion, shorten the LOS is one of the pressing needs. Fully utilize the existing resources to provide extra service is a formidable challenge, our program successfully reduced half of the pre-op bed occupancy day through integrated and multidisciplinary approach.

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