Cox et al. (2016) conducted a qualitative study to examine efficient and exceptional patient experience while reducing the length of stay to fewer than three days. The study was done in the 45-bed orthopedic unit and an outpatient orthopedic clinic utilizing a mixed method approach of a paper-based survey, telephone follow-up on selected cohort patients. The study analyzed the role of patient education in ensuring that patients are prepared and easily accept care. Patient education is done to empower patients to become independent and become socially active to reduce anxiety. The study established that the main barrier to the lengths of stay in the level of mobilization the patients are subjected to while at the hospital. Moreover, the study recommended the importance of recognizing members of health care teams in ensuring a reduction in the lengths of stay at the hospital.
A quantitative study of 92 patients with a mean age of 66.6 years by Pedziwiatr et al. (2015) was conducted to examine the course of the implementation of the enhanced recovery after Surgery (ERAS) on adherence to protocol. The study established that in order to ensure the successful introduction of enhanced recovery after surgery protocol there is a need for increased compliance. Due to this, postoperative complications are decreasing, and the length of stay is easily shortened. Also, there is a need for close cooperation, continuous education, and evaluation of results to enhance ERAS protocol.
Harikesavan, Chakravarty, & Maiya (2019) examined the influence of early mobilization on pain, self-reported and performance-based functional measures following total knee replacement. The study was conducted in Manipal Hospital, India from April 2015 to December 2016 to investigate the relationship. The study found out that early mobilization increases knee joint loading during walking and standing thereby leading to stability in the knee as well as reducing pain during recovery. Also, the study established that pain reduction during early mobilization enhances knee stability.
Zhang et al. (2018) conducted a study to identify the complete preoperative, perioperative and postoperative factors associated with long postoperative lengths of stay after primary TKA in a detailed enhanced recovery after surgery program. The study examined 241 participants in West China between July 2015 and March 2017 to analyze the postoperative length of stay. The study found out that postoperative complications increased with an increase in the postoperative length of stay (Tan, Hunt, & Gwini, 2018). The study further recommended for the focus on the improvement of surgical techniques by the enhanced recovery after surgery program as well as optimization of perioperative management to help in discharging patients.
Rolfson et al. (2016) conducted a study to define a minimum standard set of outcome measures and case-mix factors for monitoring, comparing, and improving healthcare for patients with clinically diagnosed hip or knee osteoarthritis. The qualitative study developed a standard set using a modified Delphi process between July 2014 and March 2015. The findings of the study were knowledge improves and empowers providers to ensure increased care as well as lead to improved decision making involving healthcare spending (Tan, Hunt, & Gwini, 2018). Also, the study established that valued-based healthcare system could benefit through transparency and well-aligned incentives.
Mobilization of patients on the day of hip arthroplasty shortens the time to readiness for discharge from the hospital according to the study by Sarin et al. (2016). The study investigated government-funded hospital in Perth, Western Australia which had no facilities of high dependency or intensive care unit. The study was done for three years to investigate hip resurfacing at the hospitals. The study established that there is no significant difference between poorly equipped and well-equipped hospitals in handling patients with hip or knee problems. The main concern was to increase mobilization of patients which would aid in reducing the lengths of stay at the hospital facilities.
Wilson et al. (2015) analyzed the benefit of standardization of a readily accessible patient communication mobility. Their study aimed at describing the development, implementations, and effects of a quality improvement program for decision-making algorithm and associated bedside communication diagram related to patient mobility in four nursing units. The study involved 461-bed suburban Michigan hospital Beaumont hospital in Troy (BHT). The qualitative study established that hospital staff requires an efficient and accessible communication diagram that displays the mobility status of the patient. The also established that providing mobility status of patients in the nursing units led to an increase in the self-efficacy in patient mobility.
Finally, according to the study Pashikanti & Von (2012) to examine the efficacy of an early mobilization protocol in the medical hospitalized inpatient population. The study established that prolonged immobilization can bring about functional decline and increase in the risk of hospital-associated complications such as cancer and ulcers. Therefore, there is a need for early mobilization to ensure these issues are addressed accordingly and for the security of the inpatient population. The study found out that to enhance mobilization; there is a need for standardization of mobility protocol programs at hospitals. The mobilization has to be done at early stages to ensure the improvement of patient outcomes.
Cox, J., Cormack, C., Prendergast, M., Celestino, H., Willis, S., & Witteveen, M. (2016). Patient and provider experience with a new model of care for primary hip and knee arthroplasties International Journal of Orthopaedic & Trauma nursing doi:10.1016/j.ijotn.2015.05.00
Harikesavan, K., Chakravarty, R. D., & Maiya, A. G. (2019). Influence of earlymobilization program on pain, self-reported and performance based functional measures following total knee replacement. https://doiorg.lopes.idm.oclc.org/10.1016/j.jcot.2018.04.017
Pashikanti, L., & Von Ah, D. (2012). Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clinical Nurse Specialist, 26(2), 87-94. doi: 10.1097/NUR.0b013e31824590e6
Pedziwiatr, M., Kisialeuski, M., Wierdak, M., Stanek, M., Natkaniec, M., Matlok, M.,Budzynski, A (2015). Early implementation of Enhanced Recovery after Surgery (ERAS) protocol Compliance improves outcomes: A prospective cohort study https://doi.org/10.1016/j.ijsu.2015.06.087
Rolfson, O., Wissig, S., van Maasakkers, L., Stowell, C., Ackerman, I., Ayers, D., & Franklin, P. D. (2016). Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: consensus of the international consortium for health outcomes measurement hip and knee osteoarthritis working group. https://doiorg.lopes.idm.oclc.org/10.1002/acr.22868
Sarin, A., Litonius, E.S., Naidu,R., Yost, S.C., Varma, M.G., & Chen,L. (2016). Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. https://doi.org/10.1186/s12871-016-0223-0
Tan, N. L. T., Hunt, J. L., & Gwini, S. M. (2018). Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: a quality improvement study. BMC anesthesiology, 18(1), 64. https://doi.org/10.1186/s12871-018-0525-5
Wilson, C. M., Richards, N. L., Slavin, B., Wiechec, J., Jagow, D., Gomez, S., & Perlaki, B. (2015). Nursing staff perceptions and fall rates with a quality improvement project for mobility screening and written bedside communication: a pretest-posttest design. Retrieved from https://search-ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=109601862&site=eds-live&scope=site
Zhang, S., Huang, Q., Xie, J., Xu, B., Cao, G., & Pei, F. (2018). Factors influencing postoperativelength of stay in an enhanced recovery after surgery program for primary total knee arthroplasty. https://doiorg.lopes.idm.oclc.org/10.1186/s13018-018-0729-x
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