Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Hung OL(1), Chang WYE(1), Wong WY(1), Lee QJ(1), Yu WS(1)
Affiliation :
(1) Total Joint Replacement Centre, Department of Orthopaedics & Traumatology, Yan Chai Hospital
Introduction :
Joint replacement surgery is a common and effective procedure that can improve the quality of life for patients with severe osteoarthritis. However, successful outcomes depend on various factors, including preoperative optimization and postoperative care. This study aimed to evaluate the effectiveness of the integrated Model Service of SOP service through Nurse Clinics (IMSN) for Joint Replacement Surgery in improving patient outcomes and reducing hospital costs.
Objectives :
To evaluate the effectiveness of IMSN model in improving patient's outcome and reducing hospital cost by comparing with conventional nurse clinic.
Methodology :
Our hospital implemented the IMSN nursing service for joint replacement surgery in October 2021. The service included an initial assessment by a dedicated nurse one year before surgery. Although preadmission anaesthetist assessments were unavailable in our hospital due to a shortage of anaesthetists, the nurse addressed potential issues that could lead to cancellations, such as uncontrolled comorbidities or inadequate preoperative optimization—a letter to the patient to seek medical advice on perioperative management. One month before surgery, the nurse assessed the patient again and requested investigations based on the patient's comorbidities and age, in accordance with guidelines, to avoid unnecessary tests and reduce costs.
Result & Outcome :
Comparing the periods before and after the implementation of the IMSN nursing service, we observed significant reductions in unnecessary investigations (blood tests reduced by 65%, routine urinalysis reduced by 100%, and CXR reduced by 21% (P<0.01) in the IMSN group). The mean postoperative length of stay decreased from 5.03 days (SD 2.7) to 4.6 days (SD 3.1), P = 0.03). Additionally, patients who received the IMSN nursing service reported higher satisfaction scores, with mean scores ranging from 3.72 to 3.97 (based on a Likert scale from 1 to 4) across 19 questions.
