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Perceptions of patient education and readiness for hospital discharge following elective total hip or knee arthroplasty, and the impact on 30-day hospital readmission, are described. Evaluating patient education and readiness for hospital discharge can provide the healthcare team with a targeted focus on patients' struggle with energy, personal care, demands, and not feeling physically ready to go home.
In 2014, 370,770 total hip arthroplasties (THAs) and 680,150 total knee arthroplasties (TKAs) were performed in the United States (American Academy of Orthopaedic Surgeons, 2018). These numbers are expected to increase over 150% for each procedure by 2030. Conversely, hospital length of stay (LOS) is decreasing. For 2002-2013, mean LOS decreased for THA and TKA, respectively, from 4.06 to 2.75 days and 4.06 to 2.97 days (Molloy et al., 2017). Hospital LOS has shortened, and more patients are being discharged home after TKA without an increase in readmissions (Barad et al., 2018). Holm and coauthors (2014) investigated the impact of fast-tracking patients following THA or TKA and found a LOS of 2-4 days can be achieved for most patients independent of preoperative functional status. The average LOS at the study facility is 1.5 days. Do patients feel ready for hospital discharge despite this short LOS following elective THA or TKA?
Readiness for hospital discharge was described by Galvin and coauthors (2017) through a concept analysis. Attributes of readiness for hospital discharge included physical stability, adequate support, psychological ability, and adequate information and knowledge. Antecedents, events that must occur before readiness for hospital discharge, included knowledge or education, preparation, and time, all of which involve communication. Consequences of being ready for discharge from the hospital included fewer readmissions, higher satisfaction, and more control or power.
A goal of perioperative education is to ensure patients have the knowledge and skills to care for themselves. Shortened hospital LOS following elective THA or TKA has been a postoperative challenge in terms of time, type of information, amount of information, and mechanism of delivery. Education as an antecedent for discharge readiness and readmissions as a consequence of discharge readiness are important links to be explored in this patient population especially in light of penalties for 30-day hospital readmissions (Centers for Medicare & Medicaid Services, 2020).
Purpose
The purpose of this study...