Abstract
In a retrospective study in an academic, acute-care community hospital, we studied the possible safety and effectiveness of a practice guideline recommending early discharge from the hospital for patients having uncomplicated total knee replacement. Of 206 patients receiving knee replacements, 162 (79%) were classified by the guideline as being at low risk for complications between the 4th and 7th postoperative days. Use of the guideline could have reduced the postoperative length of stay from 7.3 +/- 2.6 days to 4 days for the 112 patients (54%) who became low risk on the 4th postoperative day. Explicit and implicit review of the quality of care determined that 157 patients (96.9%; 95% confidence interval, (92.9%, 99.0%) could have been safely transferred from the acute-care hospital to an appropriate setting when they became classified at low risk between the 4th and 7th postoperative days. Clinical practice guidelines can possibly be used to reduce the postoperative length of acute-care hospital stay for patients having knee replacements. This guideline requires further study in a controlled clinical trial before it can be recommended for use.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Audet A. M., Greenfield S., Field M. Medical practice guidelines: current activities and future directions. Ann Intern Med. 1990 Nov 1;113(9):709–714. doi: 10.7326/0003-4819-113-9-709. [DOI] [PubMed] [Google Scholar]
- Coffey R. J., Richards J. S., Remmert C. S., LeRoy S. S., Schoville R. R., Baldwin P. J. An introduction to critical paths. Qual Manag Health Care. 1992 Fall;1(1):45–54. [PubMed] [Google Scholar]
- Eddy D. M. Variations in physician practice: the role of uncertainty. Health Aff (Millwood) 1984 Summer;3(2):74–89. doi: 10.1377/hlthaff.3.2.74. [DOI] [PubMed] [Google Scholar]
- Harris W. H., Sledge C. B. Total hip and total knee replacement (2) N Engl J Med. 1990 Sep 20;323(12):801–807. doi: 10.1056/NEJM199009203231206. [DOI] [PubMed] [Google Scholar]
- Myers J. D. Preventing iatrogenic complications. N Engl J Med. 1981 Mar 12;304(11):664–665. doi: 10.1056/NEJM198103123041109. [DOI] [PubMed] [Google Scholar]
- Weingarten S. R., Ermann B., Riedinger M. S., Shah P. K., Ellrodt A. G. Selecting the best triage rule for patients hospitalized with chest pain. Am J Med. 1989 Nov;87(5):494–500. doi: 10.1016/s0002-9343(89)80603-5. [DOI] [PubMed] [Google Scholar]
- Weingarten S. R., Riedinger M. S., Shinbane J., Siegel R., Conner L., Prechtl K., Ellrodt A. G. Triage practice guideline for patients hospitalized with congestive heart failure: improving the effectiveness of the coronary care unit. Am J Med. 1993 May;94(5):483–490. doi: 10.1016/0002-9343(93)90082-Z. [DOI] [PubMed] [Google Scholar]
- Weingarten S., Agocs L., Tankel N., Sheng A., Ellrodt A. G. Reducing lengths of stay for patients hospitalized with chest pain using medical practice guidelines and opinion leaders. Am J Cardiol. 1993 Feb 1;71(4):259–262. doi: 10.1016/0002-9149(93)90787-d. [DOI] [PubMed] [Google Scholar]
- Weingarten S., Ermann B., Bolus R., Riedinger M. S., Rubin H., Green A., Karns K., Ellrodt A. G. Early "step-down" transfer of low-risk patients with chest pain. A controlled interventional trial. Ann Intern Med. 1990 Aug 15;113(4):283–289. doi: 10.7326/0003-4819-113-4-283. [DOI] [PubMed] [Google Scholar]
- Woolf S. H. Practice guidelines: a new reality in medicine. I. Recent developments. Arch Intern Med. 1990 Sep;150(9):1811–1818. [PubMed] [Google Scholar]