title: How efficient is patient discharge following lower limb arthroplasty?
abstract: BACKGROUND
  Appropriately timed patient discharge is essential for optimal patient care and efficient hospital functioning. The post-operative morbidity survey (POMS) is the only validated prospective method of measuring short-term post-operative morbidity. It has not previously been used as a bed utilisation tool.
  
  
  METHODS
  We collected POMS data from 529 consecutive lower-limb arthroplasty patients over a 1-year period and recorded the number of patients remaining in the hospital without morbidity, together with alternative reasons for remaining in hospital. Data was collected on post-operative days (POD) 3, 5, 8 and 15.
  
  
  RESULTS
  On POD 3, 45% of hip arthroplasty patients and 52% of knee arthroplasty patients remained in hospital with no identifiable morbidity. On POD 5, 53% of hip arthroplasty patients and 47% of knee arthroplasty patients remained in hospital with no identifiable morbidity. These figures declined by POD 8 and 15. The most common reason for inappropriate bed occupancy was ongoing physiotherapy and occupational therapy.
  
  
  CONCLUSIONS
  We believe POMS is able to identify patients remaining in hospital with no significant morbidity and has utility as a prospective bed utilisation tool. Addition of a mobility measure to POMS may improve its utility in detecting morbidity requiring hospitalisation, particularly following lower limb arthroplasty.
authors.affiliation: Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ashby
authors.affiliation: Surgical Outcomes Research Centre, University College London Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Matejowsky
authors.affiliation: UCL Institute of Child Health, Surgical Outcomes Research Centre, Joint UCLH/UCL Comprehensive Biomedical Research Centre, Gower Street, London, WC1E 6BT UK.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Mythen
authors.affiliation: University College London Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU UK.
authors.forename: Fares S
authors.initials: FS
authors.lastname: Haddad
authors.affiliation: UCL Institute of Child Health, Surgical Outcomes Research Centre, Joint UCLH/UCL Comprehensive Biomedical Research Centre, Gower Street, London, WC1E 6BT UK ; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, University Road, Southampton, SO17 1BJ UK ; NIHR Respiratory Biomedical Research Unit, University Hospital Southampton/University of Southampton, University Road, Southampton, SO17 1BJ UK.
authors.forename: Michael Pw
authors.initials: MP
authors.lastname: Grocott
keywords: Arthroplasty; Bed utilisation; Post-operative morbidity