Clinical information and guidance shared via a patient infotainment system can reduce hospital stay and maintain 2 medical quality for total knee arthroplasty: A single-blinded quasi-randomised controlled trial

• Published in: International journal of nursing studies 2020-04, Vol.104, p.103440-103440, Article 103440
• Main Authors: Huang, Shan, Kuo, Mei-Ling, Yu, Hsin-Ming, Huang, Chiu-Hui, Shieh, Wann-Yun, Hsu, Wei-Hsiu, Huang, Yo-Ping, Kuo, Feng-Chih, Lee, Mel S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty; Arthroplasty, Replacement, Knee - rehabilitation; Clinical information; Clinical medicine; Clinical pathway; Control groups; Critical Pathways; Emergency medical care; Female; Health care expenditures; Health literacy; Health status; Home health care; Hospital Costs - statistics & numerical data; Hospitalization; Humans; Joint replacement surgery; Joint surgery; Length of stay; Length of Stay - statistics & numerical data; Male; Medical costs; Middle Aged; Patient Education as Topic - methods; Patient infotainment system; Patient satisfaction; Physiotherapy; Precautions; Prospective Studies; Readmission; Taiwan; Total knee arthroplasty
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2019.103440

The demand for total knee arthroplasty is increasing worldwide. Optimising results and meeting patients’ expectations are more challenging than before, because the length of hospitalisation has markedly reduced and the standard care processes have been accelerated. We incorporated an interactive patient infotainment system into the standard clinical pathway for total knee arthroplasty in the hope of improving patients’ length of stay. To analyse whether incorporation of an interactive infotainment system reduced the length of stay and improved the quality of medical care (in terms of number of medical orders and emergency room returns). A prospective, quasi-randomised controlled trial. Data of 86 patients hospitalised for a unilateral total knee arthroplasty at a medical centre in Taiwan were analysed. From January 2017 to July 2017, 86 patients who underwent unilateral total knee arthroplasty and were cared for under a standard clinical pathway were included. The study group (41 patients) had access to electronic programs and video demonstrations related to health literacy, physical therapy, home care and precautions following total knee arthroplasty via a patient infotainment system, while the control group (45 patients) did not. Hospital course, quality indices, in-hospital medical costs, returns to the emergency room and readmission at 30 or 90 days were analysed and compared between the two groups of patients. The study group had a shorter length of stay (4.4 vs. 4.8 days, mean differences [MD] = −0.37, 95% CI −0.71 to −0.03, p = 0.026) and fewer medical orders (109 vs 111 orders, MD = −1.86, 95% confidence intervals (CI) −3.58 to −0.15, p = 0.047) as compared with the control group. The incidences of emergency room return and readmission to the hospital at 30 or 90 days were comparable between the two groups. No difference in the total medical cost was found between the two groups, with only the cost of laboratory tests in the study group being significantly lower than that in the control group ($144 vs. $163, MD = −21.7, 95% CI −41.0 to −2.25, p = 0.007). The incorporation of a patient infotainment system into the standard clinical pathway for total knee arthroplasty can efficiently reduce the length of hospital stay and maintain the quality of medical care. Further studies on improvement of patient medical literacy with the help of the infotainment system would be of interest in order to improve clinical practice and patient satisfaction. NCT037887