Prospective monitoring improves outcomes of primary total hip replacement: a cohort study

<p>Abstract</p> <p>Background</p> <p>Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with...

Full description

Bibliographic Details
Main Authors: Zayed Gamal, Pesantez Rodrigo F, Portocarrero Julio, Kerguelén Carlos A, Navas José, Pachón Marcela, Streubel Philipp N, Carrillo Germán, Llinás Adolfo M
Format: Article
Language:English
Published: BMC 2009-04-01
Series:Patient Safety in Surgery
Online Access:http://www.pssjournal.com/content/3/1/7
id doaj-81949339b8f24414a28bced5adb5619d
record_format Article
spelling doaj-81949339b8f24414a28bced5adb5619d2020-11-24T22:10:24ZengBMCPatient Safety in Surgery1754-94932009-04-0131710.1186/1754-9493-3-7Prospective monitoring improves outcomes of primary total hip replacement: a cohort studyZayed GamalPesantez Rodrigo FPortocarrero JulioKerguelén Carlos ANavas JoséPachón MarcelaStreubel Philipp NCarrillo GermánLlinás Adolfo M<p>Abstract</p> <p>Background</p> <p>Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with regular feedback sessions to the individuals involved in patient care did however not start until 2003. The present study evaluates the effect of prospective monitoring on outcomes of total hip replacement.</p> <p>Methods</p> <p>Clinical records of patients undergoing primary elective total hip replacement between 1997 and 2004 were reviewed. Data on adverse events as well as adherence to protocols for venous thromboembolism prophylaxis were extracted retrospectively for the period 1997 to 2001 and prospectively from 2003 to 2004. Results were compared and analyzed in order to establish possible improvement in outcomes. Data was analyzed with Chi-square or Fisher's Exact test for categorical variables and Student's t-test for continuous variables. Alpha was set as less than 5% and analysis was performed with Stata 9.0 for Macintosh.</p> <p>Results</p> <p>Two-hundred and eighty-three patients were included from 1997 to 2001, and 62 from 2003 to 2004. Mean age, male to female ratio and initial diagnosis were similar in both groups. At least one adverse event occurred in 45% of patients in 1997–2001 and in 21% in 2003–2004 (p < 0.001). In-hospital hip dislocations occurred in 6% and 0% (p = 0.05), oliguria in 19% and 5% (p = 0.007), SSI and VTE in 3% and 0% (p = 0.37), adverse drug reactions in 11% and 13% (p = 0.66) and non-adherence to VTE prophylaxis protocols in 15% and 2% of cases respectively (p = 0.002).</p> <p>Conclusion</p> <p>Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health care providers in order to achieve the desired effect.</p> http://www.pssjournal.com/content/3/1/7
collection DOAJ
language English
format Article
sources DOAJ
author Zayed Gamal
Pesantez Rodrigo F
Portocarrero Julio
Kerguelén Carlos A
Navas José
Pachón Marcela
Streubel Philipp N
Carrillo Germán
Llinás Adolfo M
spellingShingle Zayed Gamal
Pesantez Rodrigo F
Portocarrero Julio
Kerguelén Carlos A
Navas José
Pachón Marcela
Streubel Philipp N
Carrillo Germán
Llinás Adolfo M
Prospective monitoring improves outcomes of primary total hip replacement: a cohort study
Patient Safety in Surgery
author_facet Zayed Gamal
Pesantez Rodrigo F
Portocarrero Julio
Kerguelén Carlos A
Navas José
Pachón Marcela
Streubel Philipp N
Carrillo Germán
Llinás Adolfo M
author_sort Zayed Gamal
title Prospective monitoring improves outcomes of primary total hip replacement: a cohort study
title_short Prospective monitoring improves outcomes of primary total hip replacement: a cohort study
title_full Prospective monitoring improves outcomes of primary total hip replacement: a cohort study
title_fullStr Prospective monitoring improves outcomes of primary total hip replacement: a cohort study
title_full_unstemmed Prospective monitoring improves outcomes of primary total hip replacement: a cohort study
title_sort prospective monitoring improves outcomes of primary total hip replacement: a cohort study
publisher BMC
series Patient Safety in Surgery
issn 1754-9493
publishDate 2009-04-01
description <p>Abstract</p> <p>Background</p> <p>Over the past decade several studies have questioned current standards of patient safety in health care delivery. In response, our institution started a clinical pathway for total hip replacement in 1996. Prospective monitoring with regular feedback sessions to the individuals involved in patient care did however not start until 2003. The present study evaluates the effect of prospective monitoring on outcomes of total hip replacement.</p> <p>Methods</p> <p>Clinical records of patients undergoing primary elective total hip replacement between 1997 and 2004 were reviewed. Data on adverse events as well as adherence to protocols for venous thromboembolism prophylaxis were extracted retrospectively for the period 1997 to 2001 and prospectively from 2003 to 2004. Results were compared and analyzed in order to establish possible improvement in outcomes. Data was analyzed with Chi-square or Fisher's Exact test for categorical variables and Student's t-test for continuous variables. Alpha was set as less than 5% and analysis was performed with Stata 9.0 for Macintosh.</p> <p>Results</p> <p>Two-hundred and eighty-three patients were included from 1997 to 2001, and 62 from 2003 to 2004. Mean age, male to female ratio and initial diagnosis were similar in both groups. At least one adverse event occurred in 45% of patients in 1997–2001 and in 21% in 2003–2004 (p < 0.001). In-hospital hip dislocations occurred in 6% and 0% (p = 0.05), oliguria in 19% and 5% (p = 0.007), SSI and VTE in 3% and 0% (p = 0.37), adverse drug reactions in 11% and 13% (p = 0.66) and non-adherence to VTE prophylaxis protocols in 15% and 2% of cases respectively (p = 0.002).</p> <p>Conclusion</p> <p>Overall rate of adverse events as well as in-hospital hip dislocations, oliguria and non-adherence to VTE prophylaxis protocols were significantly reduced during the second period. We conclude that clinical pathways alone are insufficient to improve patient safety and require prospective monitoring and continuous feedback to health care providers in order to achieve the desired effect.</p>
url http://www.pssjournal.com/content/3/1/7
work_keys_str_mv AT zayedgamal prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT pesantezrodrigof prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT portocarrerojulio prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT kerguelencarlosa prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT navasjose prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT pachonmarcela prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT streubelphilippn prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT carrillogerman prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
AT llinasadolfom prospectivemonitoringimprovesoutcomesofprimarytotalhipreplacementacohortstudy
_version_ 1725808381179985920