Factors Affecting Surgical Orthopaedic
Patients’ Post-Discharge Recovery
L.L. Ouellet, RN MN & M.J. Hodgins, RN PhD (Co-Principle
Investigators)
S. Pond, RN BN; S. Knorr, RN BN & G. Geldart, RN MHSA (Co-Investigators)
Study Purpose:
The primary purposes of this study were to examine the type,
frequency and severity of problems reported by surgical orthopaedic
patients following hospital discharge and to determine the effectiveness
of a post-discharge telephone call in facilitating patients’
continued recovery during the transition from hospital to home.
Method:
The sample consisted of patients admitted to a regional, referral
hospital for either elective or emergency orthopaedic surgery.
Selection criteria included: (a) English-speaking adults, (b)
able to communicate by telephone, and (c) discharged to a private
residence with telephone access. Eligible patients were recruited
during their hospital stay. Participants were randomly assigned
to receive routine discharge care with/without a follow-up telephone
call 24 to 72 hours post-discharge. During the third week post-discharge,
a structured telephone interview was completed. Questions addressed
various aspects of participants’ physical, psychological,
and social recovery.
Results:
Information was collected from 438 participants (half of whom
had received a follow-up telephone call). The typical participant
was a middle-aged (Mean 59 years, Range 17 to 86), educated (63%
high school diploma or higher) female (55%) who underwent elective
surgery (78%). Majority of surgeries involved the lower extremity
(81%). Most participants rated their progress following discharge
as good (Mean 8 on a 11-point numerical scale) and were satisfied
with their progress (94%). Despite this, many (71%) experienced
problems following discharge that interfered with their recovery.
Study findings highlight the frequency and diversity of problems
experienced by surgical orthopaedic patients post-discharge. The
most frequently reported problems were pain, swelling, and constipation.
Women and younger participants generally reported poorer post-discharge
experiences which may be due in part to their social roles and
responsibilities. Participants who underwent total knee or hip
surgery tended to report fewer post-discharge problems. The nurse
clinicians on our team attributed this finding to the formalized
care plans used with these patients. Contrary to our expectations,
distance from hospital and season of discharge did not explain
differences in participants’ post-discharge experiences.
Overall, the most significant predictor of positive post-discharge
experience was the availability of adequate support at home. This
finding warrants consideration especially when dealing with older
patients whose primary source of help may be a spouse who may
also have health problems. We were disappointed to discover that
the telephone follow-up call did not appear to affect participants’
post-discharge experience. It is possible that these follow-up
calls were too early or too short (majority were completed on
the day following discharge and lasted less than 5 minutes).
Implications:
Although the majority of participants reported good progress
since their discharge, they also reported a number of problems.
One way to address this is by broadening the scope of care plans
so that they include the early post-discharge phase. Further research
is needed to identify and test other factors that may impact on
patients’ transition from hospital to home.
