Outcome of Care Plan for Hip Replacement Patient in Surin Hospital

Abstract

Background: Hip replacement surgery usually high cost and prolonged hospitalization, Department of orthopedic surgery therefore developed quality of care to provide professional standard care plan to enhance patient recovery and minimize complications. Discharge planning was incorporated in admission process in order to prepare caregivers to provide patient care at home.
Objective: To study outcome of care plan for hip replacement patient by comparison of control and experimental groups including identify the problems of care plan practice by multidisciplinary team.
Study design: Semi-experimental study
Method: Sample group was 40 patients who underwent hip replacement operation admitted in female orthopedic surgery ward during October 2005 - April 2008. Twenty patients were assigned for each experimental and control groups by selective randomization. Research tools had two parts; a care plan for hip replacement patient and medical care record. The research tools were tested for content validity by an expert. Data was collected by case-responsible nurses and data was analyzed by descriptive statistics such as percentage mean and standard deviation. Comparison of outcome between experimental and control group was analyzed by Independent t-test). Qualitative data was analyzed by content analysis. In control group, complication after hip replacement operation was found 20%, dislocation complication 5% and average length of stay was 20 days, cost of care per patient was 71,814.42 baht in total hip replacement and 43,702 baht in hemiarthroplasty operation. In experimental group, complication after operation was found 10%, average length of stay was 13 days, cost of care per patient was 77,946.80 baht in total hip replacement and 30,825 baht in hemiarthroplasty operation. Outcome comparison between two groups was found that length of stay was statistically different at significant level of 0.05 while cost of care per patient was not different. Problems during care plan practiced by multidisciplinary team; only 50% of physician’s interventions complied with care plan protocol while all case-responsible nurses used care plan protocol, 90% of in-charge ward nurse applied care plan protocol to practice and anesthetist visit rate were 95% and 100% in pre- and post-operative visit respectively. Operative nurse provided hip replacement information to patient at rate of 50%, physiotherapist provided physiotherapy to all hip replacement patients and social workers provided financial plan for extras or irredeemable hip prosthesis cost.
Conclusion and Suggestion: Application of care plan for hip replacement patient decreased length of stay with reasonable cost of care. Therefore the care plan should apply to all hip replacement patients and develop systematic patient care and monitoring.