Impact of Bundled Care on Outcomes Following Elective Primary Total Hip or Total Knee Arthroplasty.

BACKGROUND: Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. PURPOSE: The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). METHODS: A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. RESULTS: Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. CONCLUSION: Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.

Developing the Tracheostomy Care Anxiety Relief Through Education and Support (T-CARES) Program.

Home care of a patient with a tracheostomy after surgery for head and neck cancer requires caregivers to be comfortable with handling medical equipment and to be competent and proficient with completing many new and complex tasks. However, the responsibility of managing an artificial airway may increase caregiver anxiety, which may subsequently lead to improper care of the patient with head and neck cancer and increase the risk for complications and rate of readmission to oncology units. This article describes the development and outcomes of the Tracheostomy Care Anxiety Relief Through Education and Support (T-CARES) program, developed in response to high readmission rates for patients with head and neck cancer discharged with a tracheostomy. T-CARES consists of an 18-minute video demonstration, group discussion, return demonstration, and skills assessment. The course also incorporates hands-on practice on a low-cost anatomical task trainer created by the authors. A significant reduction in caregiver anxiety was noted after participation in the T-CARES program. T-CARES and similar programs can be developed to teach self-care for a variety of conditions that patients and caregivers are expected to manage at home.