Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative

Sharon Peacock; Jesse Wolfstadt; Miki Peer; Yehoshua Gleicher

doi:10.1136/bmjoq-2021-001698

Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative

BMJ Open Qual. 2022 Mar;11(1):e001698. doi: 10.1136/bmjoq-2021-001698.

Authors

Sharon Peacock¹, Jesse Wolfstadt², Miki Peer³, Yehoshua Gleicher⁴

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Sinai Health System, Toronto, Ontario, Canada Sharon.Peacock@sinaihealth.ca.
² Granovsky Gluskin Division of Orthopaedics, Department of Surgery, Temerty Faculty of Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Sinai Health System, Toronto, Ontario, Canada.
³ Department of Pain Management, University Health Network, Toronto, Ontario, Canada.
⁴ Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Sinai Health System, Toronto, Ontario, Canada.

Abstract

Background: Hip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients.

Methods: This was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented.

Results: After implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days.

Conclusion: Our study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.

Keywords: COVID-19; ambulatory care; healthcare quality improvement; teamwork; transitions in care.

MeSH terms

Arthroplasty, Replacement, Hip*
COVID-19*
Critical Pathways
Humans
Outpatients
Pandemics
Quality Improvement