[Care Process Improvement in Total Knee Arthroplasty Using the Concept of Patient Flow].

BACKGROUND & PROBLEM: Improving the process of care may effectively improve the quality of medical care and increase patient satisfaction. An investigation found that the process of care used in our unit was imperfect, resulting in a low preoperative enrollment rate of case managers, overly long patient waiting times for ward assignment, insufficient pre-operative knowledge, and high cancellation rates for routine operations. PURPOSE: The aim of this project was to review the overall process of care using the concept of patient flow to improve and formulate countermeasures to improve quality of care. RESOLUTION: To improve the process of care, the corresponding countermeasures were formulated. 1. Set criteria for enrollment for orthopedic case managers to increase the preoperative enrollment rate; 2. Set up a specialized arthroplasty care area for central case management to reduce the time patients need to wait for the ward; and 3. Improve patient compliance with preoperative education and reduce the operation cancellation rate by distributing patient education pamphlets, filming videos of pre-operative instructions, facilitating home environment preparation, and providing education on sterilization baths. RESULTS: After implementation of the countermeasures, the preoperative case manager enrollment rate increased from 27.8% to 84.6%; the average ward wait time for patients reduced from 73 to 41 minutes; compliance with patient education increased from 83.0% to 100%; and the operation cancellation rate reduced from 11.1% to 0%. CONCLUSIONS: This project used the concept of patient flow to review the care process used for total knee arthroplasty. This improvement strategy may be used to standardize care processes and improve the quality of medical care provided.

Health Professionals' Perspectives on the Efficacy of Using Comprehensive Care to Improve Outcomes in Patients With Traumatic Injury.

BACKGROUND: Barriers related to comprehensive posttrauma care and health outcome monitoring exist. The insights and perspectives of health professionals on this issue may help integrate care experiences to provide continuous care to patients with traumatic injury. PURPOSE: The purpose of this study was to explore the perspectives of health professionals with regard to comprehensive care to improve the outcomes of patients with traumatic injury. METHODS: Data were collected at two teaching hospitals in Taiwan. In total, 28 health professionals across various disciplines were interviewed in five focus groups. RESULTS: Six themes were delineated, including "wound care is a primary concern for patients," "ineffective health education during the hospital stay," "patients and families worry about postinjury conditions," "current continuity of care is not effective," "lack of standards for discharge planning," and "incorporation of interdisciplinary care to improve patient outcomes." CONCLUSIONS: The experiences of health professionals are useful to the establishment of a foundation for trauma case management and interdisciplinary care for hospitals.