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Reduced length of uninterrupted institutional stay after implementing a fast-track protocol for primary total hip
Konsta J Pamilo1, Paulus Torkki2, Mikko Peltola3
1a Department of Orthopaedics and Traumatology , Central Finland Hospital , Jyväskylä.
Insights
Fast-track protocols for total hip replacement (THR) significantly reduced hospital length of stay (LOS) and institutional care duration. However, careful implementation is crucial to manage potential increases in readmission rates.
Area of Science:
- Orthopedic Surgery
- Healthcare Management
- Patient Outcomes
Background:
- Fast-track protocols are increasingly adopted in hospitals to shorten patient length of stay (LOS) without compromising clinical outcomes.
- The implementation of fast-track protocols in total hip replacement (THR) surgery requires careful evaluation of its impact on institutional care and patient results.
Purpose of the Study:
- To evaluate the effect of fast-track protocol implementation on the use of institutional care and clinical outcomes after total hip replacement (THR).
Main Methods:
- A retrospective analysis of 3,193 THRs performed in four hospitals between 2009-2010 and 2012-2013.
- Hospitals were categorized as fast-track (Hospital A) or non-fast-track (Hospitals B, C, D).
- Key outcomes analyzed included LOS, length of uninterrupted institutional care (LUIC), discharge destination, readmission, revision rates, and mortality.
Main Results:
- Fast-track implementation in Hospital A led to a significant reduction in median LOS from 5 to 2 days and median LUIC from 6 to 3 days.
- The proportion of patients discharged home within one week post-THR increased significantly after fast-track implementation.
- A statistically significant increase in the 42-day readmission rate was observed following fast-track implementation (3.1% to 8.3%).
Conclusions:
- The fast-track protocol effectively reduces length of uninterrupted institutional care (LUIC) after total hip replacement (THR).
- Careful implementation and monitoring are essential to maintain the quality of care and mitigate potential increases in readmission rates associated with fast-track protocols.
Abstract:
Background and purpose - Fast-track protocols have been successfully implemented in many hospitals as they have been shown to result in shorter length of stay (LOS) without compromising results. We evaluated the effect of fast-track implementation on the use of institutional care and results after total hip replacement (THR). Patients and methods - 3,193 THRs performed in 4 hospitals between 2009-2010 and 2012-2013 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified as fast-track (Hospital A) and non-fast-track (Hospitals B, C, and D). We analyzed LOS, length of uninterrupted institutional care (LUIC, including LOS), discharge destination, readmission, revision rate, and mortality in each hospital. We compared these outcomes for THRs performed in Hospital A before and after fast-track implementation and we also compared outcomes, excluding readmission rates, with the corresponding outcomes for the other hospitals. Results - After fast-track implementation, median LOS in Hospital A diminished from 5 to 2 days (p < 0.001) and (median) LUIC from 6 to 3 (p = 0.001) days. No statistically significant changes occurred in discharge destination. However, the reduction in LOS was combined with an increase in the 42-day readmission rate (3.1% to 8.3%) (p < 0.001). A higher proportion of patients were at home 1 week after THR (p < 0.001) in Hospital A after fast-tracking than before. Interpretation - The fast-track protocol reduces LUIC but needs careful implementation to maintain good quality of care throughout the treatment process.
