Implementation of a day-stay joint replacement pathway in an Australian regional public hospital: A descriptive study

Amanda Tutty; Sam Martin; Corey Scholes; Michel Genon; Jane Linton; Simon Davidson; Christopher Williams

doi:10.1111/ajr.13127

Implementation of a day-stay joint replacement pathway in an Australian regional public hospital: A descriptive study

Aust J Rural Health. 2024 Apr 30. doi: 10.1111/ajr.13127. Online ahead of print.

Authors

Amanda Tutty^{1

2

3}, Sam Martin^{2

3}, Corey Scholes⁴, Michel Genon⁵, Jane Linton^{1

2}, Simon Davidson^{1

6}, Christopher Williams^{1

7}

Affiliations

¹ University Centre for Rural Health, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
² Grafton Base Hospital, Northern NSW Local Health District, Grafton, New South Wales, Australia.
³ The Specialist Orthopaedic Centre, Grafton, New South Wales, Australia.
⁴ EBM Analytics, Sydney, New South Wales, Australia.
⁵ Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.
⁶ Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.
⁷ Research and Knowledge Translation Directorate, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia.

PMID: 38686659
DOI: 10.1111/ajr.13127

Abstract

Objective: To describe the implementation, feasibility and safety of a day-stay joint replacement pathway in a regional public hospital in Australia.

Method: Over a 12-month pilot period, a prospective descriptive analysis of consecutive patients undergoing total knee and hip arthroplasty was conducted. The number of eligible day-stay patients, proportion of successful same-day discharges and reasons for same-day failure to discharge were recorded. Outcome measures captured for all joint replacements across this period included length of stay (LoS), patient reported outcomes, complications and patient satisfaction. The implementation pathway as well as patient and staff identified success factors derived from interviews were outlined.

Results: Forty-one/246 (17%) patients booked for joint replacement surgery were eligible for day-stay and 21/41 (51%) achieved a successful same-day discharge. Unsuccessful same-day discharges were due to time of surgery too late in the day (7/20), no longer meeting same-day discharge criteria (11/20) and declined discharge same-day (2/20). Over the implementation period 65% (162/246) of all patients were discharged with a LoS of 2 days or less. Patient satisfaction for the day-stay pathway was high. Complication rates and patient-reported outcomes were equivalent across LoS groups.

Conclusion: The day-stay joint replacement surgery pathway was feasible to implement, safe and acceptable to patients. Day-stay pathways have potential patient and system-level efficiency benefits.

Keywords: arthroplasty; orthopaedics; perioperative care; quality improvement; rural.