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[Challenges of fast-track arthroplasty in Germany]
U Nöth1, L Rackwitz2, M Clarius3
1Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland. ulrich.noeth@jsd.de.
Der Orthopade
|February 20, 2020
Summary
Germany faces challenges implementing fast-track arthroplasty due to systemic issues and resistance to change. Overcoming these requires integrated care strategies and effective change management for improved patient outcomes.
Area of Science:
- Orthopedic surgery
- Arthroplasty procedures
- Healthcare management
Background:
- Fast-track arthroplasty is widely adopted in Europe and the US but lags in Germany.
- Implementation barriers include organizational resistance, traditional practices, and reluctance towards interdisciplinary cooperation.
- The German Diagnosis Related Groups (DRG) system, with devalued compensation rates, and sector fragmentation hinder fast-track adoption.
Purpose of the Study:
- To identify the barriers to implementing fast-track arthroplasty programs in Germany.
- To propose solutions for overcoming these barriers and facilitating program adoption.
Main Methods:
- Analysis of organizational, medical, and systemic factors influencing fast-track arthroplasty implementation.
- Review of the impact of the DRG system and sector-specific challenges.
Main Results:
- Significant resistance to change, interdisciplinary collaboration, and adoption of external process analysis tools.
- Financial concerns related to the DRG system and reduced length of stay.
- Lack of integration between ambulatory, inpatient, and rehabilitation sectors.
Conclusions:
- Successful implementation of fast-track arthroplasty requires robust change management strategies.
- A shift towards sector-comprehensive care models is essential for integrating hip and knee replacement surgeries with rehabilitation.
