Page 155 - HA Convention 2015

Masterclasses

MC9.1 Nursing – Rehabilitation and Patient Empowerment 13:15 Theatre 1

The Patient Journey of Total Knee Replacement from Pre-hospital to Post-discharge
Cheng YC 1, Ho MW 1, Cheung S 1, Wong PH 1, Lam WN 1, Lai CW 1, Wong WK1, Tsang WL1, Wong MK1, Leung MF 1, Leung KH 1,
Wong MY 2, Wong YY 2, Chan TW 2, Chan KM 2
1Department of Orthopaedics and Traumatology, 2Community and Patient Resource Department,

Pamela Youde Nethersole Eastern Hospital, Hong Kong

Introduction Tuesday, 19 May

Total knee replacement (TKR) is classified as a major orthopaedic operation and our centre manages about 150 cases per
year. The concept of patient journey and patient empowerment change the way of overall management. Nowadays, the
healthcare team should focus on how to facilitate patients to move on from stage to stage smoothly.

Objectives

(1) To reduce the unexpected cancellation of operation; (2) to reduce unnecessary in-hospital stay; (3) to reduce the
unplanned readmission rate; and (4) to increase the satisfactory level of patients.

Methodology

Nurses, with the help of a group of loyal volunteers and a well-established patient support group ( 人工關節復康協會 ),
followed through TKR patients in the whole patient journey. Nurses not only provided the “need to know” information but also
offered clinical support to the patients and carers from pre-hospital to post-discharge. Primary nursing model was adopted
and clinical pathway was adhered day by day. Patients were empowered for maintenance rehabilitation and self home
care. Patients after discharge were referred to the ambulatory unit for an intensive one-stop multidisciplinary rehabilitative
training. The telephone concern service run by trained volunteers could also help to monitor patient’s status at home and
gave positive reinforcement on rehabilitative training. Unexpected complaints or queries would be forwarded to a designated
orthopaedic nurse to follow-up.

Results

From 2009 to 2014, 738 TKR patients received treatment in our unit. The unexpected cancellation of the scheduled operation
after admission was decreased from 4.9% to 1.6%. The average inpatient length of stay was reduced from 13.2 to 8.5 days.
The unplanned readmission rate was decreased from 2.5% to 2%. Both of the indicators show a better result when compared
to the benchmarks of Hospital Authority.

Over 95% of our patients could be directly discharged home as scheduled. Satisfaction of this group of patients was high (i.e.
9.3 in a 10 point Likert scale) according to a survey.

Conclusion

A well-planned patient journey and patient empowerment initiatives could physically, psychologically and socially help TKR
patients to go through hurdles in their recovery journey.

HOSPITAL AUTHORITY CONVENTION 2015

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