How efficient is patient discharge following lower limb arthroplasty?

Elizabeth Ashby, Claire Matejowsky, Michael G Mythen, Fares S Haddad, Michael PW Grocott

Appropriately timed patient discharge is essential for optimal patient care and efficient hospital functioning. The post-operative morbidity survey (POMS) is the only validated prospective method of measuring short-term post-operative morbidity. It has not previously been used as a bed utilisation tool. We collected POMS data from 529 consecutive lower-limb arthroplasty patients over a 1-year period and recorded the number of patients remaining in the hospital without morbidity, together with alternative reasons for remaining in hospital. Data was collected on post-operative days (POD) 3, 5, 8 and 15. On POD 3, 45% of hip arthroplasty patients and 52% of knee arthroplasty patients remained in hospital with no identifiable morbidity. On POD 5, 53% of hip arthroplasty patients and 47% of knee arthroplasty patients remained in hospital with no identifiable morbidity. These figures declined by POD 8 and 15. The most common reason for inappropriate bed occupancy was ongoing physiotherapy and occupational therapy. We believe POMS is able to identify patients remaining in hospital with no significant morbidity and has utility as a prospective bed utilisation tool. Addition of a mobility measure to POMS may improve its utility in detecting morbidity requiring hospitalisation, particularly following lower limb arthroplasty.