Analysis of Length of Stay, Opportunity Costs and Quality of Care in Patients with Total Knee Arthroplasty at Faculty of Medicine Ramathibodi Hospital

Tuesday, 13 July 2010

Worranan Prasanatikom, RN, PhD1
Thanya Subhadrabandhu, MD2
Hataikorn Kittimanont, RN, MS1
1Utilization Management Unit, Dean Office, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Learning Objective 1: To learn how to use data available for continuous quality improvement

Learning Objective 2: To compare the length of stay in clinical practice to the clinical pathway and describe the variations occured in clinical practice

Purpose: To analyze the length of stay (LOS) and quality of care in patients with total knee arthroplasty (TKA), to compare the difference of LOS in clinical practice and in Clinical Pathway for TKA and calculate the opportunity costs and to study the relationships between age, gender, types of patient, complication and LOS. Methods: the study design was retrospective study and secondary analysis. The sample of 260 patients with total knee arthroplasty from the Orthopedics Department during October 1, 2007 to September 30, 2008 was extracted from the database of the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. Results: Almost all of the patients were female (93.5%) with the average age of 68 years. The average LOS of 6 days in the clinical practice was equal to the LOS in the Clinical Pathway of TKA. However, the range of LOS in practice was 4 to 15 days and only 65% of the sample had LOS of 6 days. The extra bed days were 90 days and the estimated opportunity costs were 1,568,175 bahts. All the subjects had improved discharge status and no readmission within 28 days with the same disease. Types of patient and severity of complication were statistically significant related to LOS at alpha of .01. Private patients or patients with serious complication had longer LOS. Conclusion: About 65% of the patients with TKA had LOS followed the Clinical Pathway of TKA. There were variations in the process of care that resulted in shorter or longer LOS. Being private patients or having severe complications might cause longer LOS. The implication of the study was sent to the clinical lead team for clinical improvement. Patients with no complication effect should be discharged within 6 days and the Clinical Pathway of TKA should be applied to all patients.