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...

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Autores principales:	Alexandre Hardy, Jonathan Gervais-Hupé, François Desmeules, Anne Hudon, Kadija Perreault, Pascal-André Vendittoli
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Arthroplasty, replacement, knee Arthroplasty, replacement, hip Enhanced recovery after surgery Fast-track Outpatient Patient experience Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/deb02cb6bcb84ef8a2e2a8391cdf0c3c
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spelling	oai:doaj.org-article:deb02cb6bcb84ef8a2e2a8391cdf0c3c2021-11-28T12:24:27ZComparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both10.1186/s12891-021-04847-91471-2474https://doaj.org/article/deb02cb6bcb84ef8a2e2a8391cdf0c3c2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04847-9https://doaj.org/toc/1471-2474Abstract 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.Alexandre HardyJonathan Gervais-HupéFrançois DesmeulesAnne HudonKadija PerreaultPascal-André VendittoliBMCarticleArthroplasty, replacement, kneeArthroplasty, replacement, hipEnhanced recovery after surgeryFast-trackOutpatientPatient experienceDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arthroplasty, replacement, knee Arthroplasty, replacement, hip Enhanced recovery after surgery Fast-track Outpatient Patient experience Diseases of the musculoskeletal system RC925-935
spellingShingle	Arthroplasty, replacement, knee Arthroplasty, replacement, hip Enhanced recovery after surgery Fast-track Outpatient Patient experience Diseases of the musculoskeletal system RC925-935 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
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.
format	article
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
title	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_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_sort	comparing eras-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both
publisher	BMC
publishDate	2021
url	https://doaj.org/article/deb02cb6bcb84ef8a2e2a8391cdf0c3c
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Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both

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