Authors (including presenting author) :
Wong KS(1)
Affiliation :
(1)Department of Orthopaedics & Traumatology, Tseung Kwan O Hospital
Introduction :
Aging population is a worldwide problem as well as in Hong Kong. Census (2017) projected that near one third of the population will be aged over 65 in 2036. One classic age-related disorder is osteoarthritis.
In public hospitals, first line treatments for these patients are analgesic and physiotherapy. Few of them may receive intraarticular steroids or hyaluronic acid injection. When all these pain control fail, orthopedic surgeon will put these patients into a waiting list for total knee replacement. The waiting time in Kowloon East Cluster was 76 months (as in 9/2018) which was the second longest in Hong Kong (Hospital Authority, 2018). An orthopaedic joint replacement centre was thus set-up in Tseung Kwan O Hospital in October 2018 to shorten the waiting time. Its annual joint replacement will increase from 125 to 425 cases. To response to the increased case load and ensure safe patient journey, this joint centre has established a new total knee replacement patient journey with multi-disciplinary input, including a nurse clinic, that aims to shorten hospital stay from 14 days to 7 days.
Objectives :
To evaluate and make recommendation to the Joint Replacement Nurse Clinic
Methodology :
Methods: It was a retrospective cohort study. Data was collected by convenience sampling from 3 study groups (new patient journey with Nurse Clinic, new patient journey without Nurse Clinic & old patient journey) in a newly established Orthopaedic Joint Centre in a Hong Kong regional hospital. Study period were October 2018 to April 2019 for new journey and October 2017 to August 2018 for old journey. Target sample size was each group 80.
Result & Outcome :
Results: Total 290 samples were collected (new patient journey with Nurse Clinic n=66; new patient journey without Nurse Clinic n=144; old patient journey n=80).
1. Length of stay – Mean LoS for new patient journey with Nurse Clinic was 8.17 days. These patients were more adhered to target 7-day stay. Mean LoS for new patient journey without Nurse Clinic and old patient journey were 8.60 and 10.51 days respectively.
2. Pain control – At around post-operation day 16, the mean numeric pain rating scale for both new patient journey with and without Nurse Clinic were 2.68 & 2.58. Around 90% patients reported mild pain.
3. Fall incidence – No fall was reported from day of surgery to post-operation 7-9 weeks.
4. Unplanned readmission – There were less total knee replacement related unplanned readmissions in new patient journey. Lower limb swelling was common. There was no non-total knee replacement related unplanned readmission for patients with Nurse Clinic visit.
5. Patient satisfaction survey – All nursing services in all 3 groups were satisfied.
Conclusion:
Finding in this case study provided foundation for discussion to follow up service quality improvement. With review of Pre- operation Nurse Clinic content, it would be worthwhile to perform bigger scale study about the patient outcome in the future.
