Reducing Acute Hospitalization Length of Stay after Total Knee Arthroplasty: A Quality Improvement Study

Abstract Background The introduction of bundled funding for total knee arthroplasty (TKA) has motivated hospitals to improve quality of care while minimizing costs. The aim of our quality improvement project was to reduce the acute hospitalization length of stay (LOS) to less than two days and decrease the percentage of TKA patients discharged to inpatient rehabilitation using an enhanced recovery after surgery (ERAS) bundle. Methods This study used a before-and-after design. The pre-intervention period was January–December 2017 and the post-intervention period was January 2018–August 2019. A root cause analysis (RCA) was performed by a multidisciplinary team to identify barriers for rapid recovery and discharge. Four new interventions were chosen as part of an improvement bundle based on existing local practices, literature review, and feasibility analysis: 1) perioperative peripheral nerve block; 2) prophylactic antiemetic medication; 3) avoidance of routine pre-operative urinary catheterization; and 4) pre-operative patient education. Results The pre- and post-intervention groups included 232 and 383 patients, respectively. Mean LOS decreased from 2.82 to 2.13 days (P Conclusions Significant improvements in the recovery of patients after TKA were achieved by performing a RCA and implementing a multi-disciplinary, patient-centered ERAS bundle. Level of Evidence Level III