Thomas Jefferson University Hospital
 
DEPARTMENT OF ORTHOPEDIC SURGERY

About Us

Knee Replacement Quality Indicators

Average Length of Stay
The average length of stay (measured in days) provides general information about the efficiency of care delivery, and is therefore an important quality indicator. However, patients with a greater severity of illness may have a longer average length of stay.

According to the most recent national data available from the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality, the average length of stay (ALOS) for knee replacement was 3.8 days.

In 2008, Jefferson University Hospital's average length of stay (ALOS) for knee replacement was 3.55 days, which was better than the ALOS for knee replacement in the most recent HCUP data.

Antibiotic Prophylaxis
Surgical site infections affect approximately 500,000 persons per year according to a Centers for Disease Control and Prevention report. Numerous factors such as age and general health status of persons undergoing surgery can affect rates of infection at any given hospital. To prevent surgical infection, appropriate antibiotics should, as a general rule, be given within one hour of surgery and discontinued within 24 hours of surgery.

The Medicare Quality Improvement Community (MedQIC), a national knowledge forum for healthcare and quality improvement professionals, encourages careful selection and use of antibiotics for surgical procedures. The benefits of selective peri-operative antibiotic use have been repeatedly demonstrated since the 1960's (Archives of Surgery. February 2005: 140(2): 174-182).

99.29% of Jefferson Hospital's knee replacement patients received antibiotics within one hour prior to the surgical incision in 2008.

99.17% of Jefferson University Hospital's knee replacement patients had antibiotics discontinued within 24 hours after the surgery end time in 2008.

Orthopedic Services
Dedicated orthopedic units in hospitals are those that have staff members who are specifically trained to work with people who have orthopedic conditions. Having highly skilled staff, specialized equipment, and areas designed for orthopedic recovery, reduces the risk for developing avoidable problems while in the hospital.

Hospital programs, processes, and services can have an effect on the length of stay, prevent complications, and contribute to improved outcomes for persons undergoing knee replacement. (NIH Consensus Development Conference on Total Knee Replacement, December 8-10, 2003, Final Statement ; Arthritis & Rheumatism, September 2002: 46(9); 2436-2444; Journal of Nursing Administration, November, 2001: 31(11); 544-549).

Jefferson University Hospital offers a comprehensive program of services for patients undergoing knee replacement.

  • Dedicated operating room for orthopaedic surgery
  • Dedicated orthopaedic unit
  • Clinical pathways of care/ guidelines for knee replacement
  • Rehabilitation therapy available
  • Prehospital assessment and patient education programs
  • Discharge planning and coordination with home health programs
  • Joint Care Center
  • Pain Management Service

Inpatient Mortality Rate
The mortality rate (measured as a percentage) provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate. The known predictors of in-patient mortality include age and the presence of any significant coexisting conditions such as diabetes, obesity, or heart disease.

Knee replacement (knee arthroplasty) has a relatively low mortality rate. According to the most recent data available from the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ), the in-hospital death rate for knee replacement was 0.12 percent.

The inpatient mortality rate for knee replacement at Jefferson University Hospital was 0.00% in 2008, which is better than the rate for knee replacement in HCUP's Nationwide Inpatient Sample.

Correct-Patient, Correct-Procedure, Correct-Site
Wrong-patient, wrong-procedure, or wrong-site surgeries are uncommon, but they can be avoided altogether by following careful procedures prior to surgery. The following procedures cover broad areas of concern in preventing surgical mishaps; however, there are additional safeguards used by surgical teams that are not listed here.

The first procedure involves review of relevant medical records prior to surgery. These records may contain information that will prevent the need for additional tests, saving time and money. They may also provide vital facts about your health history that your surgical team needs to know.

Secondly, according to the Joint Commission's Universal Protocol for Prevention of Wrong Site, Wrong Procedure, Wrong Person Surgery, it is recommended that the operating surgeon mark the operative site using a signature or other approved mark.
Extra care should be taken with moist areas that can smear onto another site such as the inside of the thigh, according to a report in Anesthesia and Analgesia (January, 2005; 100 (1): 300). Smearing can occur where marked skin touches unmarked skin and the unintended marks may cause confusion about the correct site for surgery.

Lastly, just prior to surgery a final review is performed to ensure that the right patient is having the right procedure on the right body part, with all necessary patient information available. The armband may be checked several times during this process to verify that the team has the correct patient.

An opportunity for speaking up is provided during this final review; it is a built-in pause (time-out) to provide an opportunity for anyone on the surgical team to speak up about anything related to the procedure or patient that is questionable.

At Jefferson University Hospital, the following steps are taken to ensure correct-patient, correct-procedure and correct-site for knee surgery:

  • Pre-admission collection and review of medical records
  • Pre-operative verification checklist used (includes multiple clinical check points such as laboratory test results and arm band check)
  • Marking of site intended for surgical repair
  • Operative team review of procedure details with built-in pause (time-out)
  • Armband verification