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Type: Journal article
Title: Clinical pathway management of total knee arthroplasty: a retrospective comparative study
Author: Pearson, S.
Moraw, I.
Maddern, G.
Citation: Australian and New Zealand Journal of Surgery, 2000; 70(5):351-354
Publisher: Blackwell Science Asia
Issue Date: 2000
ISSN: 1445-1433
Abstract: <h4>Background</h4>Clinical pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The aim of the present study was to evaluate the effectiveness of a clinical pathway in improving a range of selected outcome measures in patients who have undergone total knee arthroplasty (TKA).<h4>Methods</h4>The present study was conducted at Queen Elizabeth Hospital, Adelaide. Using a retrospective comparative study design, 119 TKA patients who were managed on a clinical pathway from July 1997 to January 1998 (group 2) were compared with a retrospective group of 58 patients who underwent the same procedure from July 1996 to January 1997 (group 1) prior to the pathway's implementation. The following outcomes were measured: length of hospital stay; postoperative complications; readmissions and emergency service visits within 6 months of discharge; day of transfer to the convalescent unit; convalescent unit utilization and admission and discharge times.<h4>Results</h4>There was a significant reduction in the median length of stay in group 2 patients (9 vs 7 days; P < 0.0001). In addition there was a 66% increase in the proportion of patients in group 2 who were admitted on the day of surgery (P < 0.0001) and a 19.6% increase in the number of patients discharged within 8 postoperative days (P < 0.01). There were no significant differences between the groups with respect to the occurrence of postoperative complications. Although there was a trend toward a reduction in emergency service utilization and readmissions within 6 months of discharge for patients managed on the pathway, this was not significant.<h4>Conclusions</h4>The development and implementation of a TKA clinical pathway resulted in a significant reduction in length of stay and improved streamlining of admission, discharge and transfer processes without adversely affecting patient outcomes.
Keywords: Humans; Convalescence; Postoperative Complications; Treatment Outcome; Length of Stay; Patient Admission; Patient Discharge; Patient Readmission; Patient Transfer; Arthroplasty, Replacement, Knee; Chi-Square Distribution; Retrospective Studies; Aged; Emergency Service, Hospital; Hospital Units; Critical Pathways; Female; Male
RMID: 0001001055
DOI: 10.1046/j.1440-1622.2000.01819.x
Appears in Collections:Surgery publications

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