Patient-centric approach yields same-day discharge after knee, hip replacements

Kaiser Permanente revamped its knee and hip replacements to focus on the patient experience and found they could send many patients home on the same day as their procedure.

Healthcare delivery that looks smooth and efficient from a provider’s perspective often winds up looking like a huge waste of time for patients.

But an article in Harvard Business Review described a radical change in process that reduced the length of a hospital stay for a knee or hip replacement from three days to zero for a growing subset of Kaiser Permanente’s patients. The secret sauce was jarringly simple: The staff developed the workflow with a patient-centered mindset, seeking to use the patient’s time as efficiently as possible.

After a preliminary study of its patient population, Kaiser Permanente concluded up to half its knee and hip replacement patients could be discharged safely the same day as their procedures. As the article pointed out, zero-day hospital stays have a number of benefits including lower potential for hospital-acquired infections and a more relaxing, comfortable recovery environment. Patients also avoid the increased cost associated with an inpatient stay.

The approach does require additional effort and coordination on the part of staff. Kaiser sends care coordinators, physical therapists and pharmacists to patients’ homes to prepare them for their operation, and surgeons perform the surgery using an anterior approach designed to allow patients to walk immediately after the procedure ends. Physical therapists and care coordinators follow up at the patient’s home, and patients have an office visit with their surgeon a couple weeks later.

By using this method, Kaiser reported that it sent 11% of its recent hip and knee patients at home on the same day as their replacement, and it plans to grow that number to 50% by the end of 2018. At the same time, readmission rates for the patients with zero-day stays have been the same as those who recover in the hospital, according to the article.