Continuous quality improvement in orthopedic surgery: changes and implications with health system funding reform

Beaulé, Paul E.; Roffey, Darren M.; Poitras, Stéphane

doi:10.1503/cjs.005416

Cited by 18 publications

(12 citation statements)

References 23 publications

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“…On the other hand, over the last decades there have been many advances in the elds of biomechanics, tribology, prosthetic design and surgical technique (5,6), that have contributed to minimize the patient discomfort after arthroplasty favoring the reduction of the hospital recovery (7). Moreover, in a climate of limited resources and global nancial strain, ways of containing costs and pressure from third party payers, maintaining at the same time highly e cient care pathways, better patient satisfaction and improved patient-reported outcomes are needed (2,8).…”

Section: Trial Registrationmentioning

confidence: 99%

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Rocchi

Stagni

Govoni

et al. 2020

Preprint

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BackgroundTo date, the hip arthroplasty is one of the most commonly performed surgical procedures, with a growing worldwide demand. In recent decades, major progress made in terms of surgical technique, biomechanics and tribology knowledge have contributed to improve the medical and functional management of the patient. This study aims to assess if the application of a fast track protocol, consisting of a pre-operative educational intervention, adequate post-operative pain control and intensive rehabilitation intervention, reduces length of stay (LOS) and allows the early functional recovery compared to normal clinical practice for patients undergoing hip arthroplasty.MethodsThe study population consists of 90 patients with primary arthrosis of the hip with an anterior indication of hip arthroplasty. The exclusion criteria are older than 70 years, a contraindication to performing spinal anaesthesia and bone mass index (BMI) greater than 32. Participants, 45 for each group, are randomly allocated to one of two arms: fast track clinical pathway or standard care protocol. During allocation, baseline parameters such as Harris Hip Score (HHS) and Western Ontario and McMaster Universities index (WOMAC) are collected. On the third postoperative day, the functional autonomy for each patient is assessed by the Iowa Level of Assistance (ILOA) scale and it is expected the discharge for patients in the fast track group (primary outcome). On the other hand, standard care patient discharge is expected after 5-7 days after surgery. During follow-up fixed at 6 weeks, 3, 6 and 12 months, HHS and WOMAC scores are collected for each patient (secondary outcomes).DiscussionAlthough total hip replacement has become a widespread standardized procedure, at the author’s knowledge, only few randomized controlled trial were performed to evaluate the effectiveness of fast track pathway vs. standard care procedure in the reduction of the LOS after hip arthroplasty. It is expected that our results collected by the application of minimally invasive surgical interventions with concomitant management of perioperative pain and bleeding, and early functional rehabilitation will contribute to enrich the understanding of clinical and organizational aspects linked to fast track arthroplasty. Trial registrationClinicalTrials.gov, NCT03875976, registered on 15 March 2019 – ‘Retrospectively registered’, https://clinicaltrials.gov/ct2/show/NCT03875976

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Section: Trial Registrationmentioning

confidence: 99%

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Rocchi

Stagni

Govoni

et al. 2020

Preprint

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“…As part of our Strategic Plan (2015-2020), we are developing our comprehensive Division-wide electronic CQI database [16]. To serve as the starting point for our quality improvement initiative, the Donabedian Construct [5,17] was utilized to distinguish among the following three aspects of quality in healthcare: 1. the structure of the health care system, 2. the processes of care, and 3. the outcomes of care.…”

Section: Electronic Cqi Database For Healthcare Outcomesmentioning

confidence: 99%

Continuous Quality Improvement in Orthopaedic Surgery: Improving Patient Experience, Safety and Outcomes

Gartke

Roffey

Dobransky

et al. 2017

UOJM

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P a g e 4 9 | U O J M V o l u m e 7 I s s u e 1 | M a y 2 0 1 7 En réponse à la demande croissante de transparence et de responsabilité concernant les services de santé dispendieux, les fournisseurs de soins de santé ont mis sur pied des programmes d'amélioration continue de la qualité (ACQ) pour optimiser les soins et l'efficience. Les programmes d'ACQ qui évaluent rigoureusement les services de santé permettent des décisions plus éclairées quant aux améliorations à apporter, grâce au transfert de connaissances. Parmi les résultats positifs de ces programmes, on peut compter une plus grande satisfaction et une amélioration des résultats rapportés par les patients, des plans d'intervention particulièrement efficients, et une réduction des coûts. De nombreuses étapes dans la mise en place des programmes d'ACQ nécessitent une collaboration entre les médecins, le personnel de soutien, les gestionnaires de l'hôpital et les autres professionnels de la santé afin d'atteindre les objectifs désirés. La Division de chirurgie orthopédique de l'Hôpital d'Ottawa a lancé un programme d'ACQ conçu selon le modèle classique Donabedian, qui poursuit un triple objectif : 1. améliorer les soins, 2. améliorer l'expérience des patients, et 3. minimiser les coûts. La création d'une base de données électronique pour l'ACQ sera une composante clé du plan stratégique de 5 ans (2015-2020) de la Division, et se conforme à l'objectif de l'Hôpital d'Ottawa de devenir l'un des plus performants en Amérique du Nord, sur le plan de la qualité et de la sécurité des soins aux patients. Le but de cet article est de décrire brièvement le développement de nombreuses facettes de notre programme d'ACQ, et notre conformité aux normes de la qualité.

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“…This is especially important where quality of medical care in regards to safety and effectiveness is under increasing scrutiny. 10 These limitations are especially relevant because the incidence of patients undergoing femoroplasty as a function of the alpha angle being larger versus smaller than 55 was similar between the two groups: 66% versus 65%. Similarly, when Hooper et al 2 compared the alpha angle in patients who underwent femoroplasty versus patients who had not, the mean values were similar: 46 versus 44 .…”

mentioning

confidence: 99%

Editorial Commentary: When Is It Just a Labral Tear and Not Femoroacetabular Impingement?

Beaulé

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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How often in medicine do we have a diagnosis or pathology to evaluate and treat that hasn't previously been described? With the introduction of the concept of femoroacetabular impingement in 1999, Ganz and colleagues effectively put forth a not-previously-described diagnosis in the field of orthopaedic surgery that has expanded into the biosphere of musculoskeletal care, where we can find now research on this subject in radiology, rheumatology, biomechanics, biomedical, physical therapy, and sports medicine journals.

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Continuous quality improvement in orthopedic surgery: changes and implications with health system funding reform

Cited by 18 publications

References 23 publications

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Comparison of a Fast Track Protocol and Standard Care After Hip Arthroplasty in the Reduction of the Length of Stay and The Early Weight-Bearing Resumption: Study Protocol for a Randomized Controlled Trial

Continuous Quality Improvement in Orthopaedic Surgery: Improving Patient Experience, Safety and Outcomes

Editorial Commentary: When Is It Just a Labral Tear and Not Femoroacetabular Impingement?

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