Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

Abstract

Introduction:Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery.Theory:The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway.Methods:An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi-structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process.Results:The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1) and mobilisation & discharge (4). The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery.Conclusion:The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1), radiologist (1), anaesthetist (1), nurse specialist (1), pharmacist (1), orthopaedic surgeon (1,4), physiotherapist (1,4), nurse (4), doctor (4) and patient application (1,4). The critical value exchanges include patient preparation (mental and practical), patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

Outpatient total hip or knee arthroplasty in ambulatory surgery center versus arthroplasty ward: a randomized controlled trial

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“…In connection to the shift towards a person-centred perspective, more collaborations with designers and an increased interest in user-centred design approaches can be seen (Wildevuur 2017). To keep healthcare viable, integrated approaches for applied internet technologies and serviced design are needed that take the patient perspective into consideration (Sun et al 2014;Oosterholt et al 2017;Griffioen et al 2017).…”

Use of a Recovery Messaging Application in Outpatient Total Joint Replacement

“…A systematic review has been conducted (Bahadori et al, 2020). The remaining nine articles were observational studies categorized as prospective comparative studies, before-and-after studies, retrospective studies, and case studies (Berg et al, 2018; Dehorney & Ashcraft, 2018; Gabor et al, 2020; Glans et al, 2020; Gruskay et al, 2019; Harris et al, 2021; Lyman et al, 2020; Mascioli et al, 2021; Oosterholt et al, 2017; Zheng et al, 2019).…”