Reduced Length of Stay for Lower Limbs Arthroplasties Patients with Enhanced In-Patient Physiotherapy Program

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Authors (including presenting author) :
Chan SM(1), Lee S(1), Phang YW(1), Chung KY(2), Ho KW(2), Chiu KH(2).
Affiliation :
(1) Physiotherapy Department, Prince of Wales Hospital (2) Orthopedics & Traumatology Department, Prince of Wales Hospital.
Introduction :
With an aging population, there is an increasing demand for total joint replacement. Several joint replacements have been established to meet the demand. Significant resources have been injected to joint replacement centers to ensure smooth patient flow and fast track recovery, i.e. shorter length of stay (LOS). Prince of Wales Hospital leads in this aspect among its peer of non-joint replacement center with a short LOS for patients underwent joint replacements. To further enrich patient recovery, enhanced inpatient physiotherapy service was commenced.
Objectives :
To study the LOS of patients underwent lower limb joint replacement before and after enhanced inpatient physiotherapy service.
Methodology :
Since October 2017, inpatient physiotherapy service was enhanced for patients with lower limb post-operative status. Enhanced physiotherapy service was focused on patients after operations for lower limb fracture and lower limb joint replacement. Patients underwent lower limb joint replacement contributed to a quarter of workload of the enhanced service. Physiotherapy training is available 7 days per week, as opposed to the usual weekday training only. Twice daily training can be arranged if decided appropriate. The LOS of patients underwent elective lower limb joint replacement, including primary and revision surgeries, knee and hip replacement, under care by the Adult Joint Reconstruction team, Department of Orthopaedics and Traumatology, Prince of Wales Hospital was studied. The study aims to compare the LOS 1 year before and 1 year after commencement of the service.
Result & Outcome :
From October 2016 to September 2017, 142 patients with 143 joint replacements were performed by the team. The average LOS was 8.37 days (range, 4-42 days). Among these 142 patients, 108 patients underwent 109 total knee replacements, with average LOS of 8.06 days (range, 4-42 days. From October 2017 to September 2018, 141 patients with 152 joint replacements were performed by the team. The average LOS was 6.99 days (range, 3-34 days). Among these 141 patients, 111 patients underwent 120 total knee replacements, with average LOS of 5.59 days (range, 3-34 days. The LOS significantly improved, from 8.37 days to 6.99 days for all patients and from 8.06 days to 5.59 days for patients received total knee replacement. Total bed-day saved was 204 days for the study period, which translated to one million dollars based on the current cost of hospital bed. There was no significant difference in the complication rate and unplanned readmission rate before and after the enhanced physiotherapy service.

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