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Variance analysis in clinical pathways for total hip and knee joint arthroplasty
P Dalton1, D J Macintosh, B Pearson
1Department of Orthopaedic Surgery, Cairns Base Hospital, Queensland, Australia. daltonp@bigpond.com
Journal of Quality in Clinical Practice
|February 24, 2001
Summary
Variance analysis of clinical pathways for hip and knee replacements revealed higher-than-expected serious deviations, including cardiac events. This highlights opportunities for quality improvement in elective orthopaedic surgery.
Area of Science:
- Orthopaedic Surgery
- Healthcare Quality Improvement
- Clinical Audit
Background:
- Clinical pathways streamline patient care by sequencing critical treatment events.
- Variance analysis identifies deviations from pathways, aiding quality improvement and audits.
Purpose of the Study:
- To analyze variances in clinical pathways for total hip and total knee arthroplasty.
- To categorize variances by source and severity (serious vs. non-serious).
Main Methods:
- Prospective variance analysis of patients undergoing total hip and knee arthroplasty over 12 months.
- Categorization of variances based on source and seriousness.
Main Results:
- 12.3% of total knee replacement patients (8/65) experienced serious variances, notably cardiac events.
- 13.5% of total hip replacement patients (7/52) had serious variances.
- Overall serious variance rates exceeded expectations.
Conclusions:
- Clinical pathways integrate evidence-based medicine into practice.
- Variance analysis serves as a quality control tool to enhance patient outcomes.
- The study identified a need to address higher-than-anticipated serious variances in elective orthopaedic surgery.
