With the increased demand of total knee arthroplasty (TKA) across Ontario, coordinated efforts have been made to reduce the average length of stay (LOS) for this treatment of end-stage osteoarthritis. LOS is of significant interest as it is a major determinant of in-hospital cost and has direct implications on the quality of patient care. Currently, LOS for TKA in Ontario is approximately 3.3 days and has benefited from the improvements of standardized clinical pathways and rehabilitation protocols, spinal anaesthesia, multi-modal pain management strategies, and blood conservation. However, there is increasing evidence that reducing LOS of TKA to 2 days is not only cost-effective, but also safe for the patient.
Michael Garron Hospital wanted to explore this opportunity by reducing LOS through enhanced pre-operative patient education and counseling. This educational component was comprised of a family conference and an interview with the treating surgeon that reinforced the expectation of home discharge with out-patient physiotherapy within 2 days. Additionally, supports before and after surgery were emphasized through print patient education materials as well as consultation with a nurse case manager.
It was found that the group receiving the educational component had a significant reduction in mean LOS compared to the control group by 1.1 days. Furthermore, there was no significant difference in complication rates, re-operation rates, or re-admission rates between these two groups. This practice demonstrates the importance of managing patient expectations to improve the cost effectiveness of TKA and opens up new avenues for pre-operative patient education and counseling.