Authors (including presenting author) :
Cheung WYW, Chan TT, Ng KCK, Lai KK, Ng CC, Leung YF
Affiliation :
Kowloon East Cluster Orthopaedic Joint Centre, Department of Orthopaedics & Traumatology, Tseung Kwan O Hospital
Introduction :
Total knee replacement (TKR) surgery becomes a high volume procedure in the ageing population. Pre-operative assessment is an essential part of patient management to ensure fitness for operation. With anticipation of increase throughput and demand for resources increase in the new Joint Replacement Centre, the pre-operative assessment process has been standardized using a clinical pathway to eliminate waste.
Objectives :
To assess the effect of applying LEAN management process by using clinical pathway in the pre-operative management of patients scheduled for TKR in: (1) reducing unnecessary follow-up visits; (2) standardization of the clinical pathway.
Methodology :
A clinical pathway from one year prior to TKR to the date of operation was designed and implemented from October 2018. Three pre-operative management processes were identified: (1) collecting investigation samples; (2) reviewing investigation results; and (3) final review of patients before operation. The number of days from each of the three processes to the date of scheduled operation were collected for each of the TKR patients for the following three stages: (1) pre-implementation (January to March 2017); (2) post-implementation (January to March 2018); and (3) first month of joint centre becomes operational (October 2018).
Result & Outcome :
The number of patients recruited in the pre-implementation, post-implementation and joint centre stages were 19, 29 and 31, respectively. The median number of follow-up visits during the pre-operative year for post-implementation stages was reduced from 3 times (range 1-5) to 2 times (range 1-4) (p<0.05, Mann Whitney U-Test) and was maintained in the joint centre stage (2 times, range 1-3). Moreover, the pre-operative investigation samples were collected and reviewed closer to the date of operation in the joint centre stage compared with the post-implementation stage (joint centre stage median 64 days, range 8-178 days; post-implementation stage 94 days, range 24-214 days; p<0.05, Mann Whitney U-Test). Conclusions: The standardized pre-operative assessment clinical pathway for TKR patients is effective in reducing the number of follow-up visits, contributing to eliminate unnecessary visits, thus an important tool to tackle increase in workload efficiently.
Co-location with:
