Effects of clinical nursing pathway on the surgical site wound infection in patients undergoing knee or hip replacement surgery: A meta-analysis.

To explore the effect of clinical nursing pathway on wound infection in patients undergoing knee or hip replacement surgery. Computerised searches of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database, China National Knowledge Infrastructure databases were conducted, from database inception to September 2023, on the randomised controlled trials (RCTs) of application of clinical nursing pathway to patients undergoing knee and hip arthroplasty. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 5.4 software was employed for data analysis. Overall, 48 RCTs involving 4139 surgical patients were included, including 2072 and 2067 in the clinical nursing pathway and routine nursing groups, respectively. The results revealed, compared with routine nursing, the use of clinical nursing pathways was effective in reducing the rate of complications (OR = 0.17, 95%CI: 0.14-0.21, p < 0.001) and wound infections (OR = 0.29, 95%CI: 0.16-0.51, p < 0.001), shortens the hospital length of stay (MD = -4.11, 95%CI: -5.40 to -2.83, p < 0.001) and improves wound pain (MD = -1.34, 95%CI: -1.98 to -0.70, p < 0.001); it also improve patient satisfaction (OR = 7.13, 95%CI: 4.69-10.85, p < 0.001). The implementation of clinical nursing pathways in clinical care after knee or hip arthroplasty can effectively reduce the incidence of complications and wound infections, and also improve the wound pain, while also improving treatment satisfaction so that patients can be discharged from the hospital as soon as possible.

Identified opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey: Secondary analysis of healthcare professionals' interviews.

AIMS AND OBJECTIVES: To identify opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey in order to support patients' health-related behaviour. BACKGROUND: Gamification provides an opportunity to increase engagement in a given health behaviour and, eventually, the possibility of reaching improved outcomes through continued or consistent behaviour. DESIGN: A secondary analysis. METHODS: Semi-structured interviews were conducted with 20 healthcare professionals in a single joint-replacement centre in Finland during autumn 2018. NVivo software was used for deductive and inductive coding. The open codes were also calculated. The consolidated criteria for reporting qualitative research were followed. RESULTS: Gamification opportunities were identified related to six dimensions: accomplishment, challenge, competition, guided, playfulness and social experience. Based on the frequencies of the coded content, most opportunities for gamification can be identified in the context of personalised counselling, monitoring and social support. CONCLUSIONS: Several opportunities for gamification were identified and quantified. While various needs and limitations need to be considered when developing digital gamified solutions and more research into the effectiveness of such solutions will be required, the current study opens possible future avenues for exploring the use of gamification in lower limb joint replacement journey and other specialisms. RELEVANCE TO CLINICAL PRACTICE: This study provides an important insight into healthcare professionals' views of the current state of the total hip and knee arthroplasty journey and the potential for its development. In addition, it pinpoints the biggest opportunities for gamified services in the context of personalised counselling, monitoring and social support. Despite the focus of this secondary analysis being on the arthroplasty journey, the findings can also be generalised in other surgical journeys.

A Nurse Navigator Program Is Effective in Reducing Episode-of-Care Costs Following Primary Hip and Knee Arthroplasty.

BACKGROUND: Alternative payment models for total hip arthroplasty (THA) and total knee arthroplasty (TKA) have incentivized providers to deliver higher quality care at a lower cost, prompting some institutions to develop formal nurse navigation programs (NNPs). The purpose of this study was to determine whether a NNP for primary THA and TKA resulted in decreased episode-of-care (EOC) costs. METHODS: We reviewed a consecutive series of primary THA and TKA patients from 2015-2016 using claims data from the Centers for Medicare and Medicaid Services and Medicare Advantage patients from a private insurer. Three nurse navigators were hired to guide discharge disposition and home needs. Ninety-day EOC costs were collected before and after implementation of the NNP. To control for confounding variables, we performed a multivariate regression analysis to determine the independent effect of the NNP on EOC costs. RESULTS: During the study period, 5275 patients underwent primary TKA or THA. When compared with patients in the prenavigator group, the NNP group had reduced 90-day EOC costs ($19,116 vs $20,418 for Medicare and $35,378 vs $36,961 for private payer, P < .001 and P < .012, respectively). Controlling for confounding variables in the multivariate analysis, the NNP resulted in a $1575 per Medicare patient (P < .001) and a $1819 per private payer patient cost reduction (P = .005). This translates to a cost savings of at least $5,556,600 per year. CONCLUSION: The implementation of a NNP resulted in a marked reduction in EOC costs following primary THA and TKA. The cost savings significantly outweighs the added expense of the program. Providers participating in alternative payment models should consider using a NNP to provide quality arthroplasty care at a reduced cost.

Healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey: A qualitative interview study.

AIMS AND OBJECTIVES: To examine the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty and to understand healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey. BACKGROUND: There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. DESIGN: This was a qualitative interview study. METHODS: Semi-structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. RESULTS: Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, postdischarge care, patient counselling, communication, transparency of the journey and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. CONCLUSIONS: From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast-track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. RELEVANCE TO CLINICAL PRACTICE: More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better access to healthcare services, improved outcomes and an improved patient experience. These results can be used in the development of new eHealth solutions to support surgical care journeys and patient education.

Evaluation of a nurse-led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients: A quasi-experimental study.

AIMS AND OBJECTIVES: To measure adherence to a nurse-led evidence-based venous thromboembolism prevention programme (intervention) compared to usual care in hip and knee arthroplasty patients and associated clinical outcomes. BACKGROUND: Venous thromboembolism morbidity and mortality of hospitalised patients is a major concern for health professionals. Venous thromboembolism prevention guidelines have been developed; however, adherence to guidelines is variable. PARTICIPANTS: There were 410 potential participants who were adult patients that were booked for elective hip or knee arthroplasty at the two study sites during a 2-year period (2011-2013). Of these, 27 did not meet the inclusion criteria, and the remainder were eligible for inclusion in the study (intervention site n = 196 and control site n = 187, total population n = 383). METHODS: This study adopted a quasi-experimental design, using an intervention and control study site, conducted in two private hospitals in a regional area in Australia. RESULTS: The intervention group had a mean compliance score of 11.09, higher than the control group score of 7.19. This is equivalent to a compliance rate of 85% and 55%, respectively, and indicates that adherence at the study site was significantly higher. Patient adherence and outcomes in the postdischarge period were not significantly different between the study sites. CONCLUSION: This study demonstrated a nurse-led intervention achieved high adherence with translating evidence-based guidelines into routine patient care for hip and knee arthroplasty patients. Nurses can be critical to implementing clinical practice guidelines and adopting preventive programmes in acute care to improve patient outcomes and reduce postoperative venous thromboembolism in arthroplasty patients. RELEVANCE TO CLINICAL PRACTICE: This research demonstrates the capacity of nurses to lead the translation of evidence-based practice guidelines for prevention of venous thromboembolism into routine patient care.

Actual and perceived nursing workload and the complexity of patients with total hip arthroplasty.

BACKGROUND: Little is known about the relation between patient complexity and nursing care of total hip arthroplasty (THA) patients. To improve patient care and hospital logistics, the aim of this study is to gain insight into the relation between patient complexity and the nursing staff's actual and perceived workload at an orthopedic ward during admission for a THA. DESIGN: Prospective cohort study of 45 THA patients in the year 2014. Duration and type of nursing care activities were recorded during the first postoperative morning. A questionnaire was used to analyze the perceived workload of the nursing staff. Both actual and perceived workload were analyzed for their relation with patient complexity, expressed in the American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), Katz Activities of Daily Life score (Katz-ADL) and Body Mass Index (BMI). RESULTS: No relation was found between actual workload and measures for patient complexity. The perceived workload of the nursing staff was related to two complexity measures: ASA (r=0.71; p<0.001) and CCI (r=0.65; p=0.002). CONCLUSION: Patient comorbidity is related to the perceived workload of the nursing staff during admission for a THA. Patient complexity is not related to actual workload. This study gives a first insight into the relation between patient comorbidity and nursing staff workload, to try to improve staffing numbers at the ward as well as patient care in the process.

Walk patients through total hip arthroplasty.

Osteoarthritis is the most common cause for hip pain. Total hip arthroplasty (THA) can relieve pain and enhance mobility and quality of life for patients with arthritic hip pain. The focus of this article is THA in patients with osteoarthritis using Mr. H's case as an illustration. It reviews indications and contraindications for THA and other treatment options as well as nursing care for patients undergoing THA.

The effects of the empowerment education program in older adults with total hip replacement surgery.

AIMS: To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. BACKGROUND: Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. DESIGN: A prospective randomized control trial. METHODS: A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. RESULTS: After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. CONCLUSION: This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact.

Interventions of the nursing diagnosis "Acute Pain" ­ Evaluation of patients' experiences after total hip arthroplasty compared with the nursing record by using Q-DIO-Pain: a mixed methods study / Interventionen zur Pflegediagnose "Akute Schmerzen" ­ Evaluation der schmerzlindernden Pflege bei hospitalisierten Patientinnen und Patienten nach Hüftendoprothesenversorgung im Vergleich zur Pflegedokumentation mittels Q-DIO-Pain: eine Mixed Methods Studie.

Background: Pain affects patients' rehabilitation after hip replacement surgery. Aim: The study aim was to compare patients' responses, on their received pain relieving nursing interventions after hip replacement surgery, with the documented interventions in their nursing records. Method: A mixed methods design was applied. In order to evaluate quantitative data the instrument "Quality of Diagnoses, Interventions and Outcomes" (Q-DIO) was further developed to measure pain interventions in nursing records (Q-DIO-Pain). Patients (n = 37) answered a survey on the third postoperative day. The patients' survey findings were then compared with the Q-DIO-Pain results and cross-validated by qualitative interviews. Results: The most reported pain level was "no pain" (NRS 0 ­ 10 Points). However, 17 ­ 50 % of patients reported pain levels of three or higher and 11 ­ 22 % of five or higher in situations of motion / ambulation. A significant match between patients' findings and Q-DIO-Pain results was found for the intervention "helping to adapt medications" (n = 32, ICC = 0.111, p = 0.042, CI 95 % 2-sided). Otherwise no significant matches were found. Interviews with patients and nurses confirmed that far more pain-relieving interventions affecting "Acute Pain" were carried out, than were documented. Conclusions: Based on the results, pain assessments and effective pain-relieving interventions, especially before or after motion / ambulation should be improved and documented. It is recommended to implement a nursing standard for pain control.

Total hip replacement for developmental dysplasia of hip and postoperative nursing.

This study was designed to determine the clinical effect of total hip replacement for the treatment of developmental dysplasia of the hip (DDH) and analyze the postoperative nursing. Sixty patients (78 hips) aged 18-75 years (average 58.6±2.31 years) who received total hip replacement for treatment of DDH at the Zhengzhou People’s Hospital, Henan, China, from April 2013 to June 2016 were selected as research subjects. Twenty-four patients were male (30 hips) and 36 were female (48 hips). Of the 60 patients, according to Crowe typing, 24 were type I (30 hips), 26 were type II (34 hips), 6 were type III (8 hips) and 4 were type IV (6 hips). According to the Harris hip score system, the score of all hips was 39.46±3.56 points average (18-56 points) before treatment and resulted as 89.60±4.25 points (79-98 points) at the last follow-up, showing a statistically significant difference (P < 0.05). Complications such as wound infection, dislocation, fracture of femoral shaft, femoral nerve and injury of sciatic nerve were not found after treatment. A total of 48 cases (58 hips) obtained excellent curative results (93.33% recovery), 8 cases (14 hips) good (92.31% recovery), and 4 cases (6 hips) medium. Total hip replacement proved to be effective in treating DDH and secondary osteoarthritis. Moreover, soft tissue release and an optimum degree recovery of anatomic form and physiological function of the diseased hip is an important basis for reconstructing the acetabulum and stabilizing acetabulum prosthesis.

Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement.

OBJECTIVE: To examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for US Medicare patients following elective total hip and knee replacement. DESIGN: A cross-sectional analysis of secondary data. SETTING: Acute care hospitals in California, Florida, New Jersey and Pennsylvania, during 2006. PARTICIPANTS: Medicare patients (n = 112 017) admitted to an acute care hospital for an elective total hip or knee replacement. MAIN OUTCOME MEASURES: The adjusted odds ratio (OR) of experiencing an unplanned readmission within 10 and 30 days of discharge following an elective total hip or knee replacement. RESULTS: Our sample included 112 017 Medicare patients in 495 hospitals. Nearly 6% of the patients were readmitted within 30 days; more than half of whom were rehospitalized within 10 days. Adjusted for patient and hospital characteristics, patients had 8% higher odds of 30-day readmission and 12% higher odds of 10-day readmission, for each additional patient per nurse. Patients cared for in the best work environments had 12% lower odds of 30-day readmission. CONCLUSIONS: Readmission outcomes following major joint replacement are associated with hospital nursing care. Attention to nurse work conditions may be central to improving readmissions in this postoperative Medicare population.

Patient experience in fast-track hip and knee arthroplasty--a qualitative study.

AIMS AND OBJECTIVES: To explore the lived experience of patients in fast-track primary unilateral total hip and knee arthroplasty from the first visit at the outpatient clinic until discharge. BACKGROUND: Fast-track has resulted in increased effectiveness, including faster recovery and shorter length of stay to about two days after hip and knee arthroplasty. However, the patient perspective in fast-track with a median length of stay of less than three days has been less investigated. DESIGN: A qualitative design. METHODS: A phenomenological-hermeneutic approach was used, inspired by Paul Ricoeur's theory of narrative and interpretation. Eight patients were included. Semi-structured interviews and participant observation were performed. RESULTS: Three themes emerged: dealing with pain; feelings of confidence or uncertainty - the meaning of information; and readiness for discharge. Generally, the patients were resistant to taking analgesics and found it difficult to find out when to take supplementary analgesics; therefore, nursing staff needed enough expertise to take responsibility. Factors that increased patients' confidence: information about fast-track, meeting staff before admission and involving relatives. In contrast, incorrect or conflicting information and a lack of respect for privacy led to uncertainty. In preparing for early discharge, sufficient pain management, feeling well-rested and optimal use of time during hospitalisation were important. CONCLUSION: The study shows the importance of dealing with pain and getting the right information and support to have confidence in the fast-track programme, to be ready for discharge and to manage postoperatively at home. RELEVANCE TO CLINICAL PRACTICE: In fast-track focusing on early discharge, there is an increased need for evidence-based nursing practice, including a qualified judgement of what is best for the patient in certain situations. The knowledge should be gleaned from: research; the patients' expertise, understanding and situation; and nurses' knowledge, skills and experience.

Patients' experiences from an education programme ahead of orthopaedic surgery - a qualitative study.

AIMS AND OBJECTIVES: The objective of this study was to investigate how patient education in a surgical department was experienced by patients who had undergone total knee arthroplasty or total hip arthroplasty. BACKGROUND: Total knee arthroplasty and total hip arthroplasty are two of the most common and clinically effective surgical treatments performed in the Western world. Patient education efforts related to these procedures have been studied, but usually only to evaluate clinical outcome and little in a patient perspective. DESIGN: The empirics consist of qualitative in-depth interviews with 11 patients admitted to the surgical department at a Norwegian hospital. The interviews were carried out in 2011. METHODS: The study has a qualitative design with a phenomenological approach. The data have been analysed through meaning condensation, in accordance with Amadeo Giorgi's four-step method. N = 11. RESULTS: The education programme made the patients feel mentally prepared for surgery and the postsurgical situation. Three themes were identified: (1) realistic information preparing for surgery, (2) involvement and sense of control and (3) trust in staff. CONCLUSION: A relationship seems to exist between how informed patients feel and how much they trust the department in which they are undergoing treatment. There may also be a relationship between a sense of control and trust. RELEVANCE TO CLINICAL PRACTICE: To build a trustful relationship between healthcare providers and patients, patient education both in groups and individually should be implemented, and be designed in a way that supports trust. Information should be realistic and accurate.

The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement - a European study.

AIMS AND OBJECTIVES: To describe and compare the quality of recovery on discharge from hospital among patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors. BACKGROUND: Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today's shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with quality of recovery at discharge from hospital. DESIGN: A descriptive, comparative study including 12 hospitals in 5 European countries; Cyprus, Finland, Greece, Iceland and Sweden. METHODS: Consecutively included patients responded on: health-related quality of life, and emotions before surgery and at hospital discharge; quality of recovery, patient satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total, 865 patients were included (hip n = 413, knee n = 452). RESULTS: In the dimension of pain, patients undergoing hip replacement had significantly better quality of recovery compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer quality of recovery. Fulfilment of knowledge expectations has a limited effect on quality of recovery. Greater satisfaction with care predicted better quality of recovery. CONCLUSIONS: Negative preoperative emotions were related to poorer quality of recovery. For both kinds of arthroplasty, greater satisfaction with care was associated with better quality of recovery. RELEVANCE TO CLINICAL PRACTICE: The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

Accountability of Nursing Interventions vs. Severity of Illness Scores for the Hospital Care Cost Of Total Hip Replacement.

The main purpose of this study was to investigate the extent to which nursing care compared to severity of illness (SOI) accounted for direct hospital costs. The type, frequency, and duration of nursing interventions required for patients undergoing total hip replacement surgery by the SOI stages with independent t-tests were identified. Although patients in Stage 3 generally needed a greater amount of each intervention than patients in Stage 2, the differences in needs for nursing interventions were not consistent using SOI. With hierarchical multiple regression analyses, results indicated nursing interventions explained significantly more variability in hospital care costs than SOI scores. Relying only on SOI scores for reimbursement may not accurately reflect the resource consumption of health care.

Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective.

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.

Maintaining Unity - relatives in older patients' fast-track treatment programmes. A grounded theory study.

AIM: To generate a substantive grounded theory of relatives' pattern of behaviour in older patients' fast-track treatment programmes during total hip or knee replacement. BACKGROUND: Fast-track treatment programmes are designed to make total hip and knee replacements more efficient through recovery improvements. The support of relatives during older patients' trajectory is important. However, knowledge is needed on the relatives' pattern of behaviour to strengthen their involvement in fast-track treatment programmes. DESIGN: We used a Glaserian grounded theory approach based on a systematic generation of theory from data to explain the latent pattern of behaviour of relatives. METHODS: Data were collected from 2010-2011 in orthopaedic wards at two Danish university hospitals and consisted of 14 non-participant observations, 14 postobservational interviews and five interviews. Seven relatives of patients over 70 years of age participated. The constant comparative method was the guiding principle for simultaneous data collection, data analysis and coding, while theoretically sampling and writing memos. FINDINGS: Maintaining Unity emerged as the relatives' pattern of behaviour through which they resolved their main concern: preventing the patients from feeling alone. The relatives resolved their main concern through three interchangeable behavioural modes: Protecting Mode, by providing loving and respectful support; Substituting Mode, with practical and cognitive support; and an Adapting Mode, by trying to fit in with the patients' and health professionals' requirements. CONCLUSION: The substantive theory of Maintaining Unity offers knowledge of relatives' strong desire to provide compassionate and loving support for the older patients during fast-track treatment programmes.

Nurse-led orthopaedic clinic in total joint replacement.

OBJECTIVES: To introduce the practice of a nurse-led orthopaedic clinic for managing stable patients after total hip or knee replacement and to evaluate its efficacy. DESIGN: Case series. SETTING: A public hospital in Hong Kong. PATIENTS: Patients who had stable primary total knee replacement or total hip replacement done for longer than 2 years were managed in a nurse-led total joint replacement pilot clinic. RESULTS: From July 2012 to March 2014, 431 patients (including 317 with total knee replacement and 114 with total hip replacement) were handled, and 408 (94.7%) nurse assessments were independently performed. Six cases of prosthesis-related complications were diagnosed. One patient was hospitalised for prosthetic complications within 3 months after follow-up. The satisfaction rate was 100%. From November 2012 to April 2013, an advanced practice nurse, one resident specialist, and one associate consultant independently charted Knee Society Knee Score or Harris Hip Score for the patients attending preoperative assessment clinic to check the inter-observer reliability. Overall, 23 patients with 37 knees and 11 patients with 17 hips were examined. The mean correlation coefficient between assessments by the associate consultant and advanced practice nurse was 0.912 for Knee Society Knee Score, and 0.761 for Harris Hip Score. The advanced practice nurse could achieve better or equally good correlation with associate consultant when compared with the correlation between resident specialist and associate consultant (0.866 and 0.521 for Knee Society Knee Score and Harris Hip Score, respectively) and with international standard. CONCLUSION: Nurse-led total joint replacement clinic was safe, reliable, and well accepted by patients.

Preoperative indicators of length of stay following total hip replacement: a New Zealand-based retrospective, observational study.

AIMS AND OBJECTIVES: To identify preoperative risk factors that potentially affect postoperative length of stay of patients undergoing total hip replacement. BACKGROUND: With limited health resources and an ageing population, alongside an increasing prevalence of osteoarthritis and the growing need for total hip replacement, reducing length of stay is a mainstay of effective and cost-efficient orthopaedic practice. DESIGN: A retrospective observational study. METHODS: Data from a convenience sample of 243 patients having undergone an elective unilateral total hip replacement between January 2008-December 2009 were collected. Demographic data were studied and allied against the main preoperative risk factors--with length of stay being the main outcome measure. RESULTS: Pearson's correlation demonstrated a moderate positive correlation between age and a longer postoperative stay. The number of comorbidities did not have an impact on length of stay. Demographic findings included almost half the cohort lived with hypertension, and 66% of the available cases (n = 196) were deemed overweight. CONCLUSIONS: Collecting accurate and comprehensive assessment information relating to preoperative risk factors for total hip replacement, significantly impacts on postoperative outcomes specifically related to length of stay. RELEVANCE TO CLINICAL PRACTICE: In complex healthcare systems, where there is a need for quality client outcomes tempered against limited resources, this study highlights the benefits of accurate preassessment of orthopaedic clients undergoing major surgical intervention against the desirable outcomes of reduced lengths of admission.

Determining the cost-effectiveness of hospital nursing interventions for patients undergoing a total hip replacement.

AIM: The purposes of the study were to (i) identify the types and amounts of nursing interventions and (ii) estimate the cost-effectiveness of nursing interventions for complications the patients experienced when undergoing a total hip replacement (THR). BACKGROUND: There has been little cost-effectiveness research into nursing interventions in hospitals, resulting in an inability to explain the economic value of hospital nursing interventions. METHOD: The direct effects of nursing interventions on hospital direct costs and complication rates were analysed using path modelling, controlling for multiple factors (patient characteristics and nursing contexts) influencing nursing care. Then, cost-effectiveness ratios and the cost-effectiveness plane were used to identify cost-effective interventions. RESULTS: Intramuscular (IM)/Subcutaneous (SC) Administration was the most cost-effective nursing intervention, followed by Orthotics Management. CONCLUSIONS: The study findings can be used to promote nurses' knowledge and attitudes about the economic value of nursing and cost-effective care delivery. A sensitivity analysis with actual cost per nursing intervention and for specific complications will be necessary. IMPLICATIONS FOR NURSING MANAGEMENT: It is important for nurse administrators to support nurses' clear documentation in order to make nursing information available. Utilizing study methods and findings, nurse managers can compare the cost-effectiveness of new nursing interventions or manage dosages of nursing interventions to provide the most cost-effective nursing interventions.