Structured discharge education improves early outcome in orthopedic patients

Clinical practice recommendations for prehabilitation and post-operative rehabilitation for arthroplasty: A scoping review

BACKGROUND

The rising need for arthroplasty (joint replacement) has resulted in a significant increase in wait-times. Longer surgical wait-times may further exacerbate functional decline in adults with osteoarthritis as well as delay postoperative functional recovery. This review aims to better inform rehabilitation care provision before (prehabilitation) and after (post-rehabilitation) hip or knee arthroplasty based on recommendations from clinical practice guidelines (CPGs).

METHODS

This scoping review used a three-stage process to screen and extract articles, which resulted in 123 articles reviewed for analysis. Included CPGs were in the English language and focussed on rehabilitation interventions or practices involving adult patients preparing for or recuperating from hip and knee arthroplasty (published 2009-2020).

RESULTS

Patient assessments, use of assistive devices, as well as self-management and education programs were recommended before and after arthroplasty. Physiotherapy was recommended to support post-operative rehabilitation. Conversely, there was limited evidence supporting recommendations for or against physiotherapy during the prehabilitation phase of the arthroplasty care journey.

CONCLUSIONS

The findings from this review highlight the current gap in high-quality evidence supporting hip and knee arthroplasty rehabilitation CPGs before and after surgery. Findings warrant additional research to ensure patients are best prepared for surgery and supported for optimal recovery.

Effect of Counseling on Quality of Life and Self-Care Agency for Patients Who are Scheduled for Total Knee Replacement

This study aims to determine the effect of counseling on quality of life and self-care agency for patients who are scheduled for total knee replacement (TKR). The study has a quantitative and quasi-experimental design with a control group. The patients in the control group (n = 40) received routine care. Face-to-face and telephone counseling was offered to individuals in the intervention group (n = 39). The data was collected at face-to-face interviews by using a patient characteristics form, Quality of Life Scale, and Self-Care Agency Scale. The scores for quality of life and self-care agency in the 6th to 8th and 14th to 16th weeks after surgery were very significantly higher in the intervention group than in the control group (p < .001). This study shows that counseling given by the nurse increases the quality of life and self-care agency of patients undergoing TKR.

Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up-a qualitative study among physical trauma survivors

Background

Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care.

Method

Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach.

Results

The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge.

Conclusion

The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

[External fixation for treatment of peripartum pubic symphysis separation : Clinical case and discussion]

A complete peripartum pubic symphysis separation is a rare but severe complication of natural birth. Its incidence is estimated to be 0.03-3 ‰. Minor partial separations with a small width can be treated with a pelvic binder. Separations with major dehiscence should be treated by surgical reduction and fixation. This article presents the case of a 30-year-old woman who suffered a complete rupture of the pubic symphysis during the birth of her second child. Radiographic dehiscence was 39 mm. The operative treatment was carried out using a supra-acetabular external fixator for 12 weeks with a good result.

[Discharge education, a new type of therapeutic patient education. Quality criteria and perspective of application to our context]

Patient education prior to discharge from hospital is a practice developed under the name of "discharge education" (DE) in the Anglo-Saxon countries. This new form of patient education targets acute and sometimes chronic patients and concerns all hospital specialties ; it aims to facilitate the transition "hospitalhome" and avoid early readmissions. In this article we want to outline a framework of indications and effects of DE, starting from an analysis of the international literature, and identify its quality criteria in order to forecast the conditions of its application to our context. A scoping review allowed us to examine 43 scientific studies specifically related to the description, analysis and evaluation of discharge education, as well as some recommendations. Almost half of the studies are published in Nursing Science journals. DE is an intense and short educational intervention (30 minutes to an hour) delivered mainly in acute situations. Paediatrics has the largest number of publications together with post-operative care. In most studies, DE is effective in improving clinical and psychosocial parameters, reducing early admissions, increasing skills and patient compliance. To achieve its goals, DE must be structured and include systematic follow up. Focused on the patient's needs and his learning ability, it uses a specific interactive pedagogy to which caregivers must be trained. The analysis of the international research leaves no doubt about the positive contributions of DE. It would be important for caregivers and policymakers to look at it as an opportunity to improve the quality of care and to humanize it.

The Quality of Patient Education in Day Surgery by Adult Patients

PURPOSE

The purpose of the study was to describe the quality of patient education in day surgery as evaluated by adult patients.

DESIGN

Descriptive design using survey methodology.

METHODS

The data were collected by questionnaire and measured the quality and implementation of education resources for day surgery patients (n = 600) in a university hospital. The data were analyzed statistically using basic and multivariate methods.

FINDINGS

The implementation of patient education has been done in a patient-centered and goal-oriented way by half of respondents. Most respondents (81%) were satisfied with the interaction in patient education. The education resources were reported as good by 77% of respondents.

CONCLUSIONS

Health care staff should assess for the presence of anxiety as a barrier to the comprehension of information. In developing patient education, the professional expertise and skills of health care staff in educating patients should be used.

The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol

REVIEW OBJECTIVE

The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings.

BACKGROUND

Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care. According to Huang et al. a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al. found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al. also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence and empowerment were all improved as a result of patient education. While Johansson et al. included studies up to 2003, the proposed systematic review will include studies from 2003 to 2013.Kruzik also reported benefits of decreased length of stay, reduced pain medication requested post-operatively together with increased patient and family member satisfaction. Bastable reported benefits of patient education, including increased patient satisfaction, improved quality of life, enhanced continuity of care, decreased anxiety, fewer complications, promotion of adherence to the plan of care, maximized independence, and empowerment.Types of education involved in this systematic review are patient education, pre-operative education, and discharge education. Only one study discussed discharge education and the outcome from this review. The outcomes that have been discussed in this systematic review include length of stay, satisfaction, pain level,, 21 cost of care, functional abilities, knowledge, anxiety, and quality of life.Major outcomes discussed in these studies are length of stay, pain,, 21 functional abilities, and anxiety. Most of these studies found significant results of reduced length of stay on those patients who received patient education compared to patient who did not received any patient education or information. Studies support the positive outcomes around length of stay.Common orthopedic conditions that have been discussed are osteoarthritis with total arthroplasty either hip or knee or joint replacement. A study on spinal surgery patients and the effects of pre-operative education, which stated that although there are many studies on the effectiveness on patient education, there are missing data on spinal surgery. This study found that the implementation of patient education has positive impacts upon patient satisfaction especially in managing pain.This review will look specifically at the effectiveness of orthopedic patient education for length of stay, satisfaction, pain level, cost of care, functional ability, knowledge, anxiety, and quality of life.

Content of Orthopedic Patient Education Provided by Nurses in Seven European Countries

Patients’ and their significant others’ education during the perioperative phase is an important and challenging aspect of care. This study explored the content of education provided by nurses to arthroplasty patients and their significant others. Data were collected with the Education of Patients–NURSE content (EPNURSE-Content), Received Knowledge of Hospital Patient (RKhp), and Received Knowledge of Significant Other (RKso) scales. The results showed that the content of education emphasized biophysiological and functional needs, differed between countries, and was related to how physically demanding nurses found their job to be and the amount of education provided. There is congruence between the received knowledge of patients and their significant others in relation to the content of education provided by nurses. The findings can support nurses in developing aid material for patients and significant others explaining the nature of education and advising them what to expect and how to optimize their participation in the process.

Evaluation of discharge telephone calls following total joint replacement surgery

The average length of stay for patients undergoing total joint replacement surgery at a large teaching hospital is 3 days. This requires a comprehensive discharge education plan. The purpose of this prospective quality improvement project was to evaluate patients' understanding of postoperative care at home, screen for postoperative complications, and identify inconsistencies or gaps in discharge teaching. During a 1-year evaluation period, patients who underwent total joint replacement surgery were interviewed via a telephone call following discharge to home. Patients were asked questions regarding general feeling, pain, wound appearance, edema, anticoagulation, and physical therapy. Concerns reported most frequently included medication side effects, deep vein thrombosis prophylaxis, and the use of assistive devices. The majority of patients reported receiving adequate discharge instructions. This quality improvement project has resulted in improved discharge teaching based on patients' identified needs and early intervention for the prevention of postoperative complications.

Association between days to complete inpatient discharge summaries with all-payer hospital readmissions in Maryland

OBJECTIVE

Hospital discharge summaries can provide valuable information to future providers and may help to prevent hospital readmissions. We sought to examine whether the number of days to complete hospital discharge summaries is associated with 30-day readmission rate.

PATIENTS AND METHODS

This was a retrospective cohort study conducted on 87,994 consecutive discharges between January 1, 2013 and December 31, 2014, in a large urban academic hospital. We used multivariable logistic regression models to examine the association between days to complete the discharge summary and hospital readmissions while controlling for age, gender, race, payer, hospital service (gynecology-obstetrics, medicine, neurosciences, oncology, pediatrics, and surgical sciences), discharge location, length of stay, expected readmission rate in Maryland based on diagnosis and illness severity, and the Agency for Healthcare Research and Quality Comorbidity Index. Days to complete the hospital discharge summary-the primary exposure variable-was assessed using the 20th percentile (>3 vs ≤3 days) and as a continuous variable (odds ratio expressed per 3-day increase). The main outcome was all-cause readmission to any acute care hospital in Maryland within 30 days.

RESULTS

Among the 87,994 patients, there were 14,248 (16.2%) total readmissions. Discharge summary completion >3 days was significantly associated with readmission, with adjusted odds ratio (OR) (95% confidence interval [CI]) of 1.09 (1.04 to 1.13, P = 0.001). We also found that every additional 3 days to complete the discharge summary was associated with an increased adjusted odds of readmission by 1% (OR: 1.01, 95% CI: 1.00 to 1.01, P < 0.001).

CONCLUSION

Longer days to complete discharge summaries were associated with higher rates of all-cause hospital readmissions. Timely discharge summary completion time may be a quality indicator to evaluate current practice and as a potential strategy to improve patient outcomes. Journal of Hospital Medicine 2016;11:393-400. 2016 Society of Hospital Medicine.

Determination of Patient Learning Needs after Thyroidectomy

The purpose of this study was to determine discharge learning needs of patients undergoing thyroidectomy. The population of this descriptive study consisted of patients undergoing thyroidectomy in the Endocrine Surgery Unit of a university hospital between February and December 2013. The study included 251 patients who were discharged after thyroidectomy. Data obtained using the data collection form and the Patient Leaning Needs Scale (PLNS) were analyzed by frequency, mean, standard deviation, Kruskal Wallis and student-t tests. The mean age of the patients was 47.91±13.05 and 76.1% were females. The PLNS total mean score was 208.38±34.91, with the maximum score of 39.23±6.80 on the subscale of treatment and complications and the minimum score of 19.45±4.70 on the subscale of feelings related to condition. It was found that the PLNS total score of the patients was not influenced by age, gender, marital status (p>0.05). This study demonstrated that patients had high learning needs after thyroidectomy.

Effect of an educational intervention on parental readiness for premature infant discharge from the neonatal intensive care units

AIM

To examine the effect of an educational intervention on parental readiness for premature infant discharge from neonatal intensive care units.

BACKGROUND

Low readiness for discharge can result in negative healthcare outcomes for infants and their parents. However, few studies have examined the effect of discharge education programmes on parental readiness for premature infant discharge in Chinese critical care settings.

DESIGN

A quasi-experimental study.

METHODS

Between October 2011-March 2012, 154 parents of premature infants were recruited from neonatal intensive care units of two tertiary hospitals in Central China. These parents were assigned to either the intervention or control group based on their entry order. Parents in the intervention group received two sessions of 60-minute discharge education along with hospital routine care; parents in the control group only received hospital routine care. Parental readiness for discharge and quality of discharge education were assessed on the day of infant discharge from neonatal intensive care units. Independent samples t-test and linear regression were used to analyse the data.

RESULTS

Parental readiness for premature infant discharge was in the moderate level. Independent samples t-test showed that both mean scores of parental discharge readiness and discharge teaching quality from the intervention group were significantly higher than those in the control group. Linear regression analysis showed that discharge teaching quality explained 39·7% of the variance in parental readiness for premature infant discharge.

CONCLUSION

Discharge education can improve parental readiness for premature infant discharge. Quality of discharge teaching can significantly predict parental readiness for premature infant discharge.

People's experiences of suffering a lower limb fracture and undergoing surgery

AIMS AND OBJECTIVES

To describe people's experiences of suffering a lower limb fracture and undergoing surgery, from the time of injury through to the care given at the hospital and recovery following discharge.

BACKGROUND

There is a lack of research on people's experiences of suffering a lower limb fracture and undergoing surgery - from injury to recovery.

DESIGN

A qualitative approach was used.

METHODS

Interviews with nine participants were subjected to thematic content analysis.

RESULTS

One theme was expressed: from realising the seriousness of the injury to regaining autonomy. Participants described feelings of frustration and helplessness when realising the seriousness of their injury. The wait prior to surgery was a strain and painful experience, and participants needed orientation for the future. They expressed feelings of vulnerability about being in the hands of staff during surgery. After surgery, in the postanaesthesia unit, participants expressed a need to have control and to feel safe in their new situation. To mobilise and regain their autonomy was a struggle, and participants stated that their recovery was extended.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Participants found themselves in a new and unexpected situation and experienced pain, vulnerability and a striving for control during the process, that is, 'from realising the seriousness of the injury to regaining autonomy'. How this is managed depends on how the patient's needs are met by nurses. The nursing care received while suffering a lower limb fracture and undergoing surgery should be situation specific as well as individual specific. The safe performance of technical interventions and the nurse's comprehensive explanations of medical terms may help the patient to feel secure during the process.

A review of the literature on heart failure and discharge education

The Centers for Medicare and Medicaid Services (CMS) have proposed changes in the health care reimbursement for patients diagnosed with heart failure (HF) if readmission to a hospital occurs within 30 days of their discharge. The Joint Commission (TJC) has identified 6 key education topics for HF patients with their families that can result in decreased readmissions. Though the patient may be too ill, critical care nurses have an opportunity to begin the discharge education process immediately with families or caregivers. This literature review discusses studies focused on discharge education in general and then those studies specific to HF discharge education. This review reports on what is known or supported by evidence within 8 major topics. Finally, the discussion section summarizes the evidence for discharge education by answering 6 questions that address the "who and when" as well as the "what" of discharge education.