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[Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences].

https://arctichealth.org/en/permalink/ahliterature168857
Source
Ugeskr Laeger. 2006 May 29;168(22):2144-8
Publication Type
Article
Date
May-29-2006
Author
Henrik Husted
Hans Christian Hansen
Gitte Holm
Charlotte Bach-Dal
Kirsten Rud
Kristoffer Lande Andersen
Henrik Kehlet
Author Affiliation
H:S Hvidovre Hospital, Ortopaedkirurgisk Afdeling, Hvidovre. henrikhusted@dadlnet.dk
Source
Ugeskr Laeger. 2006 May 29;168(22):2144-8
Date
May-29-2006
Language
Danish
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - nursing - rehabilitation - statistics & numerical data
Arthroplasty, Replacement, Knee - nursing - rehabilitation - statistics & numerical data
Denmark
Early Ambulation - statistics & numerical data
Focus Groups
Hospital Departments - organization & administration - statistics & numerical data
Humans
Interviews as Topic
Length of Stay
Orthopedics - organization & administration - statistics & numerical data
Patient Discharge - statistics & numerical data
Physician's Practice Patterns
Registries
Abstract
The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in order to identify important logistical and clinical areas for the duration of the hospital stay.
According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. This took place from late 2004 to mid 2005, and all written material and 25 journals from each department were evaluated, and interviews with the heads of the departments as well as the staff were conducted. The logistical set-up and the clinical treatment/pathway were examined in an attempt to identify logistical and clinical factors acting as improvements or barriers for quick rehabilitation and subsequent discharge.
Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more time on and up-to-date information including expectations of a short stay, functional discharge criteria) and clinical features (multi-modal pain treatment, early mobilization and discharge when criteria were met) facilitating quick rehabilitation and discharge.
Implementation of logistical and clinical features, as shown in this study in all departments, are expected to increase rehabilitation and reduce the length of hospital stay.
PubMed ID
16768951 View in PubMed
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[Length of stay in total hip and knee arthroplasty in Danmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark].

https://arctichealth.org/en/permalink/ahliterature168858
Source
Ugeskr Laeger. 2006 May 29;168(22):2139-43
Publication Type
Article
Date
May-29-2006
Author
Henrik Husted
Hans Christian Hansen
Gitte Holm
Charlotte Bach-Dal
Kirsten Rud
Kristoffer Lande Andersen
Henrik Kehlet
Author Affiliation
H:S Hvidovre Hospital, Ortopaedkirurgisk Afdeling, Hvidovre. henrikhusted@dadlnet.dk
Source
Ugeskr Laeger. 2006 May 29;168(22):2139-43
Date
May-29-2006
Language
Danish
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - adverse effects - mortality - rehabilitation
Arthroplasty, Replacement, Knee - adverse effects - mortality - rehabilitation
Cost Savings
Denmark - epidemiology
Early Ambulation - economics - statistics & numerical data
Humans
Length of Stay - economics - statistics & numerical data
Patient Discharge - statistics & numerical data
Postoperative Complications - economics - epidemiology - mortality
Registries
Abstract
The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in Denmark in order to focus on the relationship between duration of hospital stay, surgical volume, morbidity and mortality and resources.
According to the National Register on Patients in 2004 concerning postoperative length of hospital stay, readmissions (30 days) and mortality (30 and 90 days), departments with short and long hospital stay were compared and potential economical savings were estimated if all departments reduced their stays to match the departments with the shortest hospital stay.
Postoperative hospital stay varied between departments from 4.5 to 12 days. Two-thirds of the departments had stays of more than seven days. A high surgical volume tended to correlate with short hospital stay and reduced mortality. A nation-wide reduction of hospital stay after THA and TKA to five days would free 28,000 hospital beds and produce economic savings of approx. 13 million Euro.
Nation-wide implementation of fast-track THA and TKA would result in a significant decrease in the needed number of hospital beds and generate economic savings with similar or better outcome.
PubMed ID
16768950 View in PubMed
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Room for improvement in the treatment of hip fractures in Denmark.

https://arctichealth.org/en/permalink/ahliterature138943
Source
Dan Med Bull. 2010 Dec;57(12):A4199
Publication Type
Article
Date
Dec-2010
Author
Ingrid Egerod
Kirsten Rud
Kirsten Specht
Pia Søe Jensen
Anne Trangbaek
Ingerlise Rønfelt
Birte Kristensen
Henrik Kehlet
Author Affiliation
The University Hospitals' Centre for Nursing and Care Research, Rigshospitalet, København Ø, Denmark. ie@ucsf.dk
Source
Dan Med Bull. 2010 Dec;57(12):A4199
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Denmark - epidemiology
Female
Hip Fractures - complications - epidemiology - therapy
Humans
Incidence
Length of Stay
Male
Medical Audit
Recovery of Function
Retrospective Studies
Treatment Outcome
Abstract
Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records.
This was a national multicenter audit of hospital charts from each hospital treating = 50 hip fracture patients per year (n = 594).
The study demonstrated significant variability in treatment and care of patients with hip fractures among the regions of Denmark. Pain management, nutritional screening, ambulation characteristics, training in activities of daily living, and rehabilitation planning were consistently inadequate. Length of stay was 7-11 days.
Although the principles for fast-track surgery have been adapted to some extent at all departments in Denmark with an annual treatment of at least 50 patients with hip fractures, no single department has implemented the whole package. Hospital stay has been reduced since the introduction of fast-track regimes, and improvements were seen in many of the quality indicators. Implications for future practice include better adherence to clinical guidelines, a more homogeneous documentation system in nursing, promotion of evidence-based standards, and improved treatment and care of the physical and psychological consequences of hospitalization.
PubMed ID
21122457 View in PubMed
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Standardising fast-track surgical nursing care in Denmark.

https://arctichealth.org/en/permalink/ahliterature104325
Source
Br J Nurs. 2014 May 8-21;23(9):471-6
Publication Type
Article
Author
Dorthe Hjort Jakobsen
Kirsten Rud
Henrik Kehlet
Ingrid Egerod
Author Affiliation
Clinical Head Nurse at the Unit of Perioperative Nursing, Rigshospitalet.
Source
Br J Nurs. 2014 May 8-21;23(9):471-6
Language
English
Publication Type
Article
Keywords
Denmark
Evidence-Based Nursing - standards - trends
Humans
Nursing Staff, Hospital - standards - trends
Perioperative Nursing - standards - trends
Quality Improvement
Rehabilitation Nursing - standards - trends
Abstract
Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.
PubMed ID
24820811 View in PubMed
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