Dr Michael Murphy1,2, Ms Mel Hortz1
1Mater Health, Brisbane, Australia, 2The University of Queensland, St Lucia, Australia
Hip and knee arthroplasty volume has increased dramatically in the past decade increasing pressure on health care service capacity and resources. The challenge for service providers is to continue to provide high quality evidence based care, but to do so as efficiently as possible. A key area of cost reduction and increasing capacity is reducing hospital length of stay (LOS). Enhanced Recovery after Surgery (ERAS) programs are multifaceted models of care which improve efficiency and have demonstrated effectiveness in reducing LOS. In the orthopaedic setting one part of ERAS is commencing mobilisation on the day of surgery (DOS), but few studies have isolated its effect on LOS.
A retrospective audit of patients who underwent unilateral primary hip or knee arthroplasty at the Mater Hospital Brisbane was conducted to determine the LOS of patients who had mobilised successfully with physiotherapists on the DOS. Other outcomes included American Society of Anaesthesiologists’ (ASA) score, which assesses overall physical health, age and reason for unsuccessful mobilisation.
Patients who successfully mobilised on the DOS had significantly shorter LOS compared to those who did not (4.3days±1.8, 5.1±1.8, p<0.001). There was no significant difference in age between mobilising and non-mobilising groups (69.5±8.4, 69.0±9.9, p=0.71), or in ASA (2.31±0.6, 2.46±0.63, p=0.06). Importantly only 20% of eligible patients were given the opportunity to mobilise (mobilised n=74, not mobilised n=299). The main reason for not mobilising was staffing, with 53% of non-mobilised patients returning to the ward after physiotherapists’ shifts had concluded, and 15% transferred to intensive care for other comorbidities, where staff were not familiar with the mobilisation protocol.
This audit demonstrated that mobilising patients on the DOS significantly reduces LOS. Further development of this protocol will focus on multidisciplinary systemic restructuring including physiotherapy staff rostering, operating theatre timing and staff and patient education.
Michael Murphy is an advanced practice physiotherapist in orthopaedics at Mater Hospital Brisbane involved with clinical education, research and an expanded scope arthroplasty review clinic.