[Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences].
BACKGROUND
The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in order to identify important logistical and clinical areas for the duration of the hospital stay.


METHODS
According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. This took place from late 2004 to mid 2005, and all written material and 25 journals from each department were evaluated, and interviews with the heads of the departments as well as the staff were conducted. The logistical set-up and the clinical treatment/pathway were examined in an attempt to identify logistical and clinical factors acting as improvements or barriers for quick rehabilitation and subsequent discharge.


RESULTS
Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more time on and up-to-date information including expectations of a short stay, functional discharge criteria) and clinical features (multi-modal pain treatment, early mobilization and discharge when criteria were met) facilitating quick rehabilitation and discharge.


CONCLUSIONS
Implementation of logistical and clinical features, as shown in this study in all departments, are expected to increase rehabilitation and reduce the length of hospital stay.
Husted
Henrik
H
H:S Hvidovre Hospital, Ortopaedkirurgisk Afdeling, Hvidovre. henrikhusted@dadlnet.dk
Hansen
Hans Christian
HC
Holm
Gitte
G
Bach-Dal
Charlotte
C
Rud
Kirsten
K
Andersen
Kristoffer Lande
KL
Kehlet
Henrik
H
D019644:Arthroplasty, Replacement, Hip / Q000451:nursing / Q000534:rehabilitation / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000451:nursing / Q000534:rehabilitation / Q000706:statistics & numerical data; D003718:Denmark; D004434:Early Ambulation / Q000706:statistics & numerical data; D017144:Focus Groups; D006748:Hospital Departments / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D007902:Length of Stay; D009985:Orthopedics / Q000458:organization & administration / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D012042:Registries