Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both
Abstract Background Optimizing patients’ total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surger...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-021-04847-9 |
| _version_ | 1818851454027300864 |
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| author | Alexandre Hardy Jonathan Gervais-Hupé François Desmeules Anne Hudon Kadija Perreault Pascal-André Vendittoli |
| author_facet | Alexandre Hardy Jonathan Gervais-Hupé François Desmeules Anne Hudon Kadija Perreault Pascal-André Vendittoli |
| author_sort | Alexandre Hardy |
| collection | DOAJ |
| description | Abstract Background Optimizing patients’ total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs. Methods We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients’ characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. Results The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients’ THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (rs = + [0.36–0.66], p-value < 0.01). Conclusion Whatever the perioperative program, the key to improving patients’ THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients’ experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients’ THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams. |
| first_indexed | 2024-12-19T07:05:17Z |
| format | Article |
| id | doaj.art-deb02cb6bcb84ef8a2e2a8391cdf0c3c |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-19T07:05:17Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-deb02cb6bcb84ef8a2e2a8391cdf0c3c2022-12-21T20:31:19ZengBMCBMC Musculoskeletal Disorders1471-24742021-11-0122111110.1186/s12891-021-04847-9Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent bothAlexandre Hardy0Jonathan Gervais-Hupé1François Desmeules2Anne Hudon3Kadija Perreault4Pascal-André Vendittoli5Department of Biomedical Sciences, Faculty of Graduate and Postdoctoral Studies, Université de MontréalSchool of Rehabilitation, Faculty of Medicine, Université de MontréalCentre de recherche de l’Hôpital Maisonneuve-RosemontSchool of Rehabilitation, Faculty of Medicine, Université de MontréalDepartment of Rehabilitation, Faculty of Medicine, Université LavalHôpital Maisonneuve-Rosemont, Surgery Department, Université de MontréalAbstract Background Optimizing patients’ total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs. Methods We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients’ characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. Results The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients’ THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (rs = + [0.36–0.66], p-value < 0.01). Conclusion Whatever the perioperative program, the key to improving patients’ THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients’ experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients’ THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.https://doi.org/10.1186/s12891-021-04847-9Arthroplasty, replacement, kneeArthroplasty, replacement, hipEnhanced recovery after surgeryFast-trackOutpatientPatient experience |
| spellingShingle | Alexandre Hardy Jonathan Gervais-Hupé François Desmeules Anne Hudon Kadija Perreault Pascal-André Vendittoli Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both BMC Musculoskeletal Disorders Arthroplasty, replacement, knee Arthroplasty, replacement, hip Enhanced recovery after surgery Fast-track Outpatient Patient experience |
| title | Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both |
| title_full | Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both |
| title_fullStr | Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both |
| title_full_unstemmed | Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both |
| title_short | Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both |
| title_sort | comparing eras outpatient versus standard inpatient hip and knee replacements a mixed methods study exploring the experience of patients who underwent both |
| topic | Arthroplasty, replacement, knee Arthroplasty, replacement, hip Enhanced recovery after surgery Fast-track Outpatient Patient experience |
| url | https://doi.org/10.1186/s12891-021-04847-9 |
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