The Cost of Routine Follow-Up in Total Joint Arthroplasty and the Influence of These Visits on Treatment Plans.

INTRODUCTION: Many physicians recommend annual or biennial visits after total hip and knee arthroplasty (THA and TKA). This study sought to establish the cost of a post-operative visit to both the health care system and patient and identify if these visits altered patient management. METHODS: A prospective cohort study was conducted using patients presenting for follow-up after THA or TKA from April through December 2016. All surgeries were performed by a single orthopaedic surgeon in Wichita, Kansas. All eligible subjects that met the inclusion criteria received and completed a questionnaire about the personal cost of the visit and their assessment of their function and outcome after total joint arthroplasty. The physician also completed a questionnaire that examined the cost of the visit to the health care system and whether the clinical or radiographic findings altered patient management. RESULTS: Fifty-six patients participated with an average length of follow- up of 4.5 ± 4.1 years since surgery. The average patient cost was $135.20 ± $190.53 (range, $1.65 - $995.88), and the average visit time for the patient was 3.9 ± 2.9 hours. Eighty percent of patients reported no pain during the clinic encounter, and 11% reported loss of function. Eighty-four percent thought the visit was necessary. Physician time for each visit lasted 12.9 ± 3.7 minutes (range, 10 - 20 minutes). Only 9% of patient encounters resulted in an alteration in patient management. This occurred at an average follow-up time of 3.6 ± 1.8 years after the index procedure. The average cost of each visit to the health care system at large was $117.31 ± 60.53 (range, $93.90 - $428.28). CONCLUSIONS: The findings of this study advise total joint patients and orthopaedic surgeons regarding the cost of routine post-operative appointments and whether these visits alter patient management. The majority of the routine follow-up visits after THA and TKA did not result in an alteration in patient management, but added substantial cost to the health care system.

Education in critical care nursing: a new beginning.

The movement of nurse education to the tertiary sector is all but complete in Australia. Trends are changing as new partnerships are being forged and the focus of education is now reponsive to economic and political factors. These factors have resulted in the regionalisation of health care facilities and the de-institutionalisation of health services in Queensland. Moreover, de-institutionalisation of services coupled with economic rationalism has pre-empted the offering of post-graduate clinical courses by university nursing faculties. This paper addresses the process of developing the content of new courses under the umbrella of the Graduate Diploma/Masters in Critical Care Nursing offered at Griffith University Gold Coast. This initiative is the first in Queensland and has provided new vision in education for critical care nursing. This course includes a tapestry of theoretical knowledge enhancing clinical and factual subjects presented by experienced clinicians teaching with academics. The collaborative nature of nursing practice is reflected in academics and clinicians working jointly in course development, teaching and clinical placement. Strategies which were developed collaboratively addressed course content including logistics, time management, the critical selective selection of appropriate content, assessment critera, 'registerbility' within Queensland and other states, and clinical competence will be addressed. Moreover, this process of developing the course content utilised Australian National Registering Authority (ANRAC 1990) Competencies and Benners' (1984) use of the Dreyfus model to guide the expected knowledge level of the clinician at course completion. In particular this paper will not only address the blending of theory and practice to consolidate the relationship inherent between the clinician and education, but will establish the fact that no gap exists.

Health assessment and the nursing process: a means to an end?

The content and process of teaching health assessment coupled with the nursing process gathers momentum because it is consistent with health policy based on the principles of economic rationalism, and it covertly perpetuates positivist medical discourse while overtly postulating the emancipatory nature of adopting such practices.

A sharing in critical thought by nursing faculty.

A critical analysis of nurse education programmes has revealed an overt and covert curriculum; the overt being the one underpinned by values which espouse humanism and critical thought; the covert being the one which reflects the patriarchal system and is directed by a means-end rationality. In response to this dilemma the 'curriculum revolution' mandate for change, which occurred in the latter half of the last decade, called for nurse educators to unveil, understand and criticize the assumptions and values which guided their practice, so that they, and consequently their students, could be more responsive to the needs of society, value subjective experience, acknowledge theoretical pluralism, and share an egalitarian relationship. This paper explores the formation of a 'critical collective' of nurse academics who came together believing that, 'if you always do what you've always done, you'll always get what you've already got'. The major concern of this collective was to facilitate change within their work environment, through the development of strategies, so that the ideas of the 'revolution' were not lost to the mere rhetoric of curriculum documents.