Exploring the Impact of an Elective Joint Replacement Care Pathway in a Safety-Net Hospital: Ongoing Quality Improvement

Abstract

One of the innovative ways that organizations have tried to bridge the gap between quality and cost is with the implementation of care pathways. Truman Medical Center (TMC), a safety-net hospital, has implemented a multidisciplinary care pathway for patients undergoing an elective joint replacement in an effort to increase quality and control cost. The pathway, developed by a multidisciplinary team, addresses care of elective joint replacement patients through the continuum of care. The purpose of this ongoing quality project was to explore the impact of the implementation of an elective joint replacement pathway on quality outcomes and the nurses perceptions of the benefits and challenges associated with the care pathway implementation. The three study questions for this ongoing quality improvement project were: (1) does the implementation of a care pathway decrease length of stay for patients undergoing an elective joint replacement? (2) Does the implementation of a care pathway decreases readmission rates post elective joint replacement surgery? and (3) What are staff perceptions regarding the benefits and challenges of the implementation of the elective joint replacement care pathway? This quality improvement project obtained data in two ways. The first was a review of available agency outcomes data. The second was a survey of nursing staff on the orthopedic nursing unit. All data collected was organized and evaluated by the primary author. The assumptions were that both length of stay and readmission rates would decrease with implementation of a care pathway. The findings of this ongoing quality improvement project will help to determine if further study is needed on this topic of interest.