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Impact of Bundled Care on Outcomes Following Elective Primary Total Hip or Total Knee Arthroplasty

Arkin, Laura C.; Reising, Ellen; Penoyer, Daleen; Talbert, Steve

doi: 10.1097/NOR.0000000000000573
Original Articles

BACKGROUND: Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes.

PURPOSE: The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA).

METHODS: A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate.

RESULTS: Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η2 = 0.003. There were no differences in readmission rates between the 2 groups.

CONCLUSION: Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.

Laura C. Arkin, MSN, APRN-CNS, ONC, CCNS, Orthopaedic Clinical Nurse Specialist, Orlando Health, Orlando Regional Medical Center, Orlando, FL.

Ellen Reising, MSN, APRN-CNS, ACCNS-AG, Clinical Nurse Specialist, General Surgery, Orlando Health Dr. P. Phillips Hospital, Orlando, FL.

Daleen Penoyer, PhD, RN, CCRP, FCCM, Director of Center for Nursing Research, Orlando Health, Orlando, FL.

Steve Talbert, PhD, RN, Assistant Professor, College of Nursing, University of Central Florida, Orlando, FL.

We hereby certify that, to the best of our knowledge, no aspect of our current personal or professional situation might reasonably be expected to affect significantly our views on the subject on which we have written.

The authors have disclosed no conflicts of interest.

© 2019 National Association of Orthopaedic Nurses