Clinical pathway management of total knee arthroplasty: a retrospective comparative study.
BACKGROUND
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).


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Pearson
S
S
University of Adelaide, Department of Surgery, Queen Elizabeth Hospital, South Australia, Australia.
Moraw
I
I
Maddern
G J
GJ
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D016009:Chi-Square Distribution; D003289:Convalescence; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D005260:Female; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay; D008297:Male; D010343:Patient Admission; D010351:Patient Discharge; D010359:Patient Readmission; D010360:Patient Transfer; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome