Patient experience with early discharge after total knee arthroplasty: a focus group study

Høvik, Lise Husby; Aglen, Bjørg; Husby, Vigdis Schnell

doi:10.1111/scs.12514

Cited by 29 publications

(104 citation statements)

References 56 publications

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“…Multidisciplinary pathways may be more difficult to understand by socially frail patients, be it for cognitive decline, isolation, language, ethnicity, or education level. Despite patients often appreciate a reduction in hospital LOS [ 74 ], they are also worried about being left alone to fragmented healthcare [ 75 , 76 ]. In the short term, part of these issues can be resolved by proper patient or family education, which is provided within the ERAS pathway, and it is perceived as exhaustive by the professionals involved (“Is patient-information about the technology exhaustive?”).…”

Section: Discussionmentioning

confidence: 99%

“…In the short term, part of these issues can be resolved by proper patient or family education, which is provided within the ERAS pathway, and it is perceived as exhaustive by the professionals involved (“Is patient-information about the technology exhaustive?”). In order to take the best advantage from patient education [ 65 , 74 , 77 ], information must be clear, accessible, and the more patient-centred as possible [ 78 ]. In the long term, improved coordination between healthcare institutions and dedicated training to the professionals involved may also play a positive role.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Vanni

Foglia

Pennestrì

et al. 2020

BMC Health Serv Res

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Background: The number of patients undergoing joint arthroplasty is increasing worldwide. An Enhanced Recovery After Surgery (ERAS) pathway for hip and knee arthroplasty was introduced in an Italian high-volume research hospital in March 2018. Methods: The aim of this mixed methods observational study is to perform a health technology assessment (HTA) of the ERAS pathway, considering 938 procedures performed after its implementation, by means of a hospitalbased approach derived from the EUnetHTA (European Network for Health Technology Assessment) Core Model. The assessment process is based on dimensions of general relevance, safety, efficacy, effectiveness, economic and financial impact, equity, legal aspects, social and ethical impact, and organizational impact. A narrative review of the literature helped to identify general relevance, safety and efficacy factors, and a set of relevant sub-dimensions submitted to the evaluation of the professionals who use the technology through a 7-item Likert Scale. The economic and financial impact of the ERAS pathway on the hospital budget was supported by quantitative data collected from internal or national registries, employing economic modelling strategies to identify the amount of resources required to implement it. Results: The relevance of technology under assessment is recognized worldwide. A number of studies show accelerated pathways to dominate conventional approaches on pain reduction, functional recovery, prevention of complications, improvements in tolerability and quality of life, including fragile or vulnerable patients. Qualitative surveys on clinical and functional outcomes confirm most of these benefits. The ERAS pathway is associated with a reduced length of stay in comparison with the Italian hospitalization average for the same procedures, despite the poor spread of the pathway within the country may generate postcode inequalities. The economic analyses show how the resources invested in training activities are largely depreciated by benefits once the technology is permanently introduced, which may generate hospital cost savings of up to 2054,123.44 € per year. Conclusions: Galeazzi Hospital's ERAS pathway for hip and knee arthroplasty results preferable to traditional approaches following most of the HTA dimensions, and offers room for further improvement. The more comparable practices are shared, the before this potential improvement can be identified and addressed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Vanni

Foglia

Pennestrì

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…[52][53][54] Determination and ability to cope at home have been shown as the main determinants in a successful surgical outcome and these skills could be strengthened by education, knowledge, and predictability. 55 Four main areas are related to good coping after discharge home. A patient's ability to express that it was good to go home and care for themselves, feeling secure after returning home, sharing their experience with others, and predicting postoperative pain were the key areas to successful rapid recovery at home.…”

Section: Support System and Home Dischargementioning

confidence: 99%

“…A patient's ability to express that it was good to go home and care for themselves, feeling secure after returning home, sharing their experience with others, and predicting postoperative pain were the key areas to successful rapid recovery at home. 55 The preoperative education class is an opportunity to further define the patients' social network and ensure they have sufficient resources available to successfully recover at home.…”

Section: Support System and Home Dischargementioning

confidence: 99%

Preoperative Care of the TKA Patient

2018

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Total knee arthroplasty continues to increase in popularity and remains the most common joint replacement surgery. The success of total knee replacement surgery is attributed to improved outcomes, a better patient experience, and lower cost. Rapid recovery total knee replacement protocols have led to these advances by decreasing length of hospital stay, minimizing readmissions, and reducing the cost of surgery. Rapid recovery total knee replacement pathway efforts should focus on preoperative education, optimization of modifiable risk factors, and identification of patients that may not be suitable for this pathway.

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“…Previous qualitative ERAS research has focused on colorectal patients (e.g. Bernard and Foss, 2014; Fecher-Jones and Taylor, 2015; Gillis et al, 2017; Norlyk and Harder, 2009; Short et al, 2016), with the small remaining literature covering liver resection (Vandrevala et al, 2016), hip/knee replacement (Høvik et al, 2017; Hunt et al, 2009; Specht et al, 2016) and general and oncological gynaecology (Archer et al, 2014; Wagner et al, 2004, 2005). There is little research on gynaecological patients’ experiences (Paton et al, 2014), although around 55,000 women undergo hysterectomies in the United Kingdom annually and about one in five women will have a hysterectomy (The Hysterectomy Association, n.d.).…”

Section: Introductionmentioning

confidence: 99%

Experiences of enhanced recovery after surgery in general gynaecology patients: An interpretative phenomenological analysis

Phillips

Archer

Montague

et al. 2019

Health Psychology Open

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There is little qualitative research exploring non-cancer gynaecology patients’ experiences of enhanced recovery after surgery (ERAS) protocols. Seven women participated in audio-recorded interviews, discussing their experiences of enhanced recovery after surgery for gynaecological surgery. Data were transcribed and analysed using interpretative phenomenological analysis. Three themes were identified: meeting informational needs, taking control of pain, and mobilising when feeling fragile. Control emerged as a key element throughout the themes and was supported by provision of factual information. While participants were generally satisfied with their experience, topics such as concerns about analgesic use, the informal role of staff in mobilisation, and the expressed desire for more experiential information for participants require further research.

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Patient experience with early discharge after total knee arthroplasty: a focus group study

Cited by 29 publications

References 56 publications

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Preoperative Care of the TKA Patient

Experiences of enhanced recovery after surgery in general gynaecology patients: An interpretative phenomenological analysis

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