The cost effectiveness of streamlined care pathways and product standardization in total knee arthroplasty

The orthopaedic department at Providence Medical Center, Seattle, Washingto n, instituted a streamlined care pathway and product standardization for to tal knee arthroplasty (TKA) in July 1995. The goal was to reduce operating room time and to streamline the care pathway for a safe, expedited hospital ization of patients. The hospital staffs standardized nursing orders, cut t he instrument systems from 13 to 4 sets, and coordinated the expedited care pathway. Fifty-two consecutive primary TKAs were compared prepathway to 77 consecutive primary TKAs postpathway. The average length of stay declined 1.9 days from 5.1 to 3.2. The tourniquet time declined from 61 minutes to 5 6 minutes. The average dollar charges were $1,063 less. There were no infec tions in either group. The manipulation rate for adhesions declined 37%.