Page 183 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP6.6 Managing Service Demands 10:45 Room 221

A Study on Impact of Clinical Pathway Implementation and Setting up of Joint Replacement Centre on Service

Quality in Kowloon Central Cluster
So HKE 1, Wong KFJ 2, Li W 2, Sit YK 2, Yeung STE 2, Wong HSS 1, Chan CKW 3, Cheuk T 4, Lo CYA 5
1Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital,
2Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, 3Multidisciplinary Simulation and Skills Centre,
Queen Elizabeth Hospital, 4Hospital Chief Executive’s Office, Hong Kong Buddhist Hospital, 5Cluster Chief Executive’s Office,

Queen Elizabeth Hospital, Hong Kong

Introduction

In response to a large service gap in 2009 in Kowloon Central Cluster (KCC), clinical pathways in total hip replacement (THR)
and total knee replacement (TKR) surgery were implemented and the Buddhist Hospital Joint Replacement Centre (BHJRC)
was established.

Objective Tuesday, 19 May

To evaluate the effectiveness and safety of clinical pathways for primary THR and TKR in two different locations, Queen
Elizabeth Hospital (QEH) and BHJRC by comparing the post-perative length of stay (LOS), 30-day mortality, 30-day surgical
site infections (SSI) and 30-day readmission.

Methodology

Clinical pathways are multidisciplinary peri-operative care plans outlining the optimal sequencing and timing of interventions
based on best available evidence. In 2011, clinical pathways for primary and revision THR and TKR were fully implemented
in KCC to facilitate and streamline patient management. In order to optimise resources utilisation, revision and primary THR
and TKR were carried out in QEH, an acute hospital with casemix of other orthopaedic operations like trauma and tumour
surgery, and community hospital based BHJRC was dedicated to primary THR and TKR. The outcome measures for THR
and TKR in QEH from 2008 to 2009 under traditional standard of care formed the baseline. The data were compared against
the same set of data for primary THR and TKR with clinical pathways at Group one (QEH in 2013 to 2014) and Group two
(BHJRC in 2013 to 2014). Differences of the baseline in post-operative LOS, mortality, readmission rate and SSI rate after
implementation of clinical pathways in the two hospitals with different settings were analysed.

Results

Compared to baseline, there was a significant reduction in the LOS in Group one from a mean of 14.6 days to 10.7 days and
15.6 days to 9.0 days, with a reduction of 3.9 and 6.6 days respectively after clinical pathway implementation (P<0.0005). The
mean LOS in Group two was significantly reduced by 6 days and 8.3 days respectively as compared to the baseline group
(P<0.0001). There was no difference in mortality, readmission rate and SSI. As a result, the practice of clinical pathway for
primary THR/TKR and the settings of JRC are two independent factors to improve the quality and efficiency of KCC joint
replacement service.

HOSPITAL AUTHORITY CONVENTION 2015

181