Patient-centered approach enables same-day discharge after knee and hip replacements

Delivering health care that seems fluid and efficient from a provider’s perspective often ends up looking like a huge waste of time for patients.

But a Harvard Business Review article described a radical process change that reduced the length of hospital stay for knee or hip replacements from three days to zero for a growing subset of Kaiser Permanente patients. The secret sauce was disconcertingly simple: the staff developed the workflow with a patient-centered mindset, seeking to use the patient’s time as efficiently as possible.

After a preliminary study of its patient population, Kaiser Permanente concluded that up to half of its knee and hip replacement patients could be safely discharged the same day as their procedures. As the article pointed out, zero-day hospital stays have a number of advantages, including a lower potential for nosocomial infections and a more relaxing and comfortable recovery environment. Patients also avoid the increased costs associated with an inpatient stay.

The approach requires additional effort and coordination on the part of the staff. Kaiser sends care coordinators, physiotherapists and pharmacists to patients’ homes to prepare them for their operation, and surgeons perform the operation using an anterior approach designed to allow patients to walk immediately after the procedure is completed. . Physiotherapists and care coordinators follow up in the patient’s home, and patients have an office visit with their surgeon a few weeks later.

Using this method, Kaiser reported that she had sent 11% of her recent hip and knee patients home on the same day as their replacement, and that she planned to increase that number to 50% by the next. end of 2018. At the same time, Readmission rates for patients with zero-day stays were the same as those recovering in hospital, according to the article.

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