Patient Education Quarterly: Shortened LOS proves beneficial to teaching

As length of hospital stay for total-hip and total-knee surgery got shorter and shorter, there was no longer enough time to provide all the necessary education on the inpatient setting at Sacred Heart Medical Center in Spokane, WA.

As a curriculum for outpatient teaching was developed, however, it became evident that some information delivered in advance could make for a better recovery.

To have any results from pre-op strengthening exercises, patients must learn and perform them several weeks in advance, explains Kristine Becker, RN, MHA, ONC, director of orthopedics at Sacred Heart. Also, it’s better for patients to learn how to adapt their home so they have gotten rid of throw rugs and installed handrails where necessary and can be discharged to a safe environment.

During a two-year study, Becker discovered that total-hip surgery patients who attended the class were discharged a half-day sooner than those who did not. Also, 70% of those patients went home rather than to an interim facility, while only 54% of patients who did not attend the total-hip class were able to go home after their discharge. Total-knee surgery patients attending the class had a 0.4 day shorter discharge than those who did not, which was close to half a day.

Staff on the units prefer to be assigned to patients who attend the class because they participate more fully in their recovery process, Becker says. In class, patients are given a rundown of what happens on the day of surgery from where they park when they arrive at the hospital to the sights and sounds they might expect when they awake following surgery. They also are told about the role they have in their care, such as communicating to the care team about pain so it can be effectively managed.

Physical therapy teaches patients pre-op strengthening exercises and about precautions they need to take during their recovery process. All the information taught in the class also is given to patients in a three-ring binder, and they are asked to bring it with them to the hospital. "We distributed these booklets throughout the continuum, so everyone is talking from the same booklet," says Becker. That includes the surgeon’s office, home health, and the nursing homes.

For patients who have been to a class, much of the inpatient teaching is review. Also, they are in a better position to ask good questions because they have been thinking about the information they have been given, says Becker. Yet teaching during the hospital stay is tailored to meet the needs of every patient. For example, if patients have a lot of stairs in their home, the staff will work with them on climbing stairs.

There are some hospitals that cancel the surgery if patients don’t attend the pre-op class, but Sacred Heart Medical Center is not one of them, says Becker. Instead, the orthopedic department has worked hard at trying to get patients to the class in a timely manner before surgery. At first, the scheduler at the surgeon’s office was asked to do it, but time constraints caused the patients to fall through the cracks.

The orthopedic department took over the process. When a patient is scheduled for surgery, his or her name, address, and phone number is placed in the internal data system. This contact information is used to send a letter four weeks prior to the surgery letting the patient know a place in the class is reserved for him or her.

"We let them know their surgeon recommends they attend the class and that and other patients have found it very valuable. We ask them to call and confirm so we can put them on the valet parking list," Becker says.

How successful this method will be has yet to be determined because it was recently implemented. The prior method of telephoning patients was not successful because they often could not be reached, or when they returned the call the appropriate person in the orthopedic department was not available. Patients who miss the reserved class are given a call to see if they can be scheduled for a class at another date.

The total-hip-surgery class lasts about 1½ hours on Mondays while the total-knee-surgery class held on Tuesdays lasts about an hour. "It is free to the patient and is time-efficient. We have arranged free valet parking for convenience," says Becker. The class helps decrease the anxiety patients often have prior to surgery, she says.

Another challenge has been reaching patients who live 40-100 miles away and don’t want to drive to Spokane for the class. Sacred Heart Medical Center produced a total-knee-surgery video to support patients in outlying areas. While it follows the content of the notebook, it is best for people to be in the class interacting with other patients who might have questions they had not thought of yet.

In the future, Becker hopes to be able to use interactive technology to connect patients in remote areas with the teachers and students in the classroom at Sacred Heart so that they can participate in the classes.