Effectiveness of best practice implementation in reducing hip arthroplasty length of stay.

A transfer of a best practice model was performed between a new institution in the United Kingdom and a leading orthopedic hospital in the United States. The quality concepts transferred to the UK were surgical and hospital throughput, hospital facility design, an Interdisciplinary Preoperative Patient Education Program, infection control standards, and a standardized rehabilitation model. The new hospital was officially opened in February 2004, and the average length of stay for total hip arthroplasty between February and December 2004 was 6.1 +/- 3.0 days, a substantial reduction of 5 days on average. The infection rate was reduced from 1% to 0.16%. This study supports the notion that the implementation of a best practice approach significantly reduces length of stay as well as infection rate.

Randomized trials to modify patients' preoperative expectations of hip and knee arthroplasties.

UNLABELLED: Patients have multiple expectations of THA and TKA. We asked whether preoperative educational classes addressing recovery during the first year could modify patients' expectations of their 12-month postoperative recovery. Participants were enrolled consecutively in two randomized, controlled trials, one for THA (177 patients) and one for TKA (143 patients). Control patients preoperatively received a standard THA or TKA class addressing recovery immediately after surgery. Intervention patients preoperatively received the standard class plus a joint-specific module addressing recovery during the first 12 months. Before and after the class, patients completed either a hip-specific or knee-specific validated expectations survey. The main outcome was the within-patient change in expectation scores (maximum increase, +100; maximum decrease, -100) before and after the class but preoperatively. Mean changes in hip scores were +3.3+/-8 for intervention patients (range, -22+/-32) and +4.9+/-8 for control patients (range, -13+/-29). Mean changes in knee scores were -3.4+/-10 for intervention patients (range, -26+/-33) and +2.4+/-10 for control patients (range, -30+/-30). Patients' preoperative expectations of their recovery from THA or TKA can be modified by preoperative educational classes. LEVEL OF EVIDENCE: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.