Display options
Cite
Sorensen L, Idemoto L, Streifel J, et al. A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty. BMJ Open Qual. 2019;8(3):e000664doi: 10.1136/bmjoq-2019-000664.
Sorensen, L., Idemoto, L., Streifel, J., Williams, B., Mecklenburg, R., & Blackmore, C. (2019). A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty. BMJ open quality, 8(3), e000664. https://doi.org/10.1136/bmjoq-2019-000664
Sorensen, Lyle, et al. "A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty." BMJ open quality vol. 8,3 (2019): e000664. doi: https://doi.org/10.1136/bmjoq-2019-000664
Sorensen L, Idemoto L, Streifel J, Williams B, Mecklenburg R, Blackmore C. A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty. BMJ Open Qual. 2019 Jul 10;8(3):e000664. doi: 10.1136/bmjoq-2019-000664. eCollection 2019. PMID: 31363504; PMCID: PMC6629414.
Copy Download .nbib Format: NLM
Share it on

BMJ Open Qual. 2019 Jul 10;8(3):e000664. doi: 10.1136/bmjoq-2019-000664. eCollection 2019.

A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty.

BMJ open quality

Lyle Sorensen, Lori Idemoto, Janet Streifel, Barbara Williams, Robert Mecklenburg, Craig Blackmore

Affiliations

  1. Department of Orthopedic Surgery, Seattle, Washington, USA.
  2. Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA.

PMID: 31363504 PMCID: PMC6629414 DOI: 10.1136/bmjoq-2019-000664

Abstract

Knee and hip arthroplasties vary in cost, quality and outcomes. We developed a Lean quality improvement intervention for knee and hip arthroplasty patients encompassing the recognition, readiness, restoration and recovery phases of care. The intervention included standardised, evidence-based pathways, shared decision making, patient and family member engagement, and transdisciplinary rounding, implemented successively through a series of rapid process improvement workshops. We evaluated the intervention through run charts and time series analysis for 2005-2014. Outcomes included length of stay (LOS), 30-day readmission, discharge disposition, postsurgical complications and patient satisfaction. Included were 4253 total joint arthroplasty procedures, 1659 hip and 2594 knee. LOS decreased from 3.2 to 2.4 days postintervention for both hip and knee patients (p<0.001). The 30-day hospital readmission rate for hip patients decreased from 3.1% (18/576) to 1.1% (5/446, p=0.032) with knee patients unchanged. Discharge to home (vs rehabilitation facility or skilled nursing facility) increased from 72% (415/576) to 91% (405/446) (p<0.001) for hip patients, and from 70% (599/860) to 87% (578/663) for knee patients (p<0.001). Our standardised multifaceted Lean quality improvement programme was associated with reduced LOS, decreased readmission rates and improved discharge disposition in total knee and hip arthroplasty patients.

Keywords: clinical practice guidelines; healthcare quality improvement; lean management; patient-centred care; shared decision making

Conflict of interest statement

Competing interests: None declared.

References

  1. J Arthroplasty. 2003 Jan;18(1):69-74 - PubMed
  2. Clin Orthop Relat Res. 2007 Apr;457:133-7 - PubMed
  3. Qual Saf Health Care. 2006 Oct;15(5):307-10 - PubMed
  4. J Bone Joint Surg Am. 2007 Apr;89(4):780-5 - PubMed
  5. J Am Coll Surg. 2007 Jul;205(1):97-100 - PubMed
  6. J Bone Joint Surg Am. 2008 Jul;90(7):1598-605 - PubMed
  7. J Arthroplasty. 2010 Jan;25(1):114-7 - PubMed
  8. Clin Orthop Relat Res. 2009 Oct;467(10):2548-55 - PubMed
  9. N Engl J Med. 2010 Aug 12;363(7):601-3 - PubMed
  10. J Bone Joint Surg Br. 2011 Jan;93(1):39-46 - PubMed
  11. Clin Orthop Relat Res. 2012 Jan;470(1):166-71 - PubMed
  12. Clin Orthop Relat Res. 2012 Apr;470(4):1004-5 - PubMed
  13. Health Aff (Millwood). 2012 Jun;31(6):1329-38 - PubMed
  14. Health Aff (Millwood). 2012 Sep;31(9):2094-104 - PubMed
  15. N Engl J Med. 2012 Dec 27;367(26):2467-9 - PubMed
  16. J Arthroplasty. 2013 Jun;28(6):904-7 - PubMed
  17. Clin Orthop Relat Res. 2014 Jan;472(1):188-93 - PubMed
  18. Clin Orthop Relat Res. 2013 Nov;471(11):3409-11 - PubMed
  19. Anesth Analg. 2014 Jun;118(6):1370-7 - PubMed
  20. J Arthroplasty. 2014 Sep;29(9):1842-5 - PubMed
  21. Am J Med Qual. 2015 Sep-Oct;30(5):425-31 - PubMed
  22. BMJ Qual Saf. 2014 Dec;23(12):970-3 - PubMed
  23. Clin Orthop Relat Res. 2014 Dec;472(12):3943-50 - PubMed
  24. Healthc (Amst). 2013 Dec;1(3-4):91-9 - PubMed

Publication Types