To audit a major metropolitan PARS and benchmark similar PARS across the state of Victoria.
A mixed methods student-led study consisted of a i) retrospective audit of admissions to The Royal Melbourne Hospital (RMH) orthopaedic service with data extracted from electronic medical records for all hip and knee joint replacements completed in 2023; and ii) benchmarking survey of follow-up care of all 24 health services (8 metropolitan, 16 regional) across Victoria completed in REDCap either over the phone or online by a musculoskeletal physiotherapist at each health service. Audit and benchmarking data were summarised descriptively via Excel and SPSS and narratively.
Of the 103 (53%) knee replacements and 118 (47%) total hip replacements completed at the RMH during 2023, median [IQR] age was 69 [60-76] years, 145 (66%) were females, and 168 (76%) were English speaking. The median [IQR] length of stay was 4 [3-7] days; 130 (59%) were discharged directly home. While all patients attended a surgical review at 6-weeks only 63 (29%) of these were referred onto PARS. This equates to an estimated cost-saving of $17,840 per year and 189 saved surgical appointments.
All health services responded to our benchmarking; 19 services currently complete joint arthroplasty with nine utilising PARS. Variability in MoC was described with patients being seen from 2-weeks, and most appointments between 3-months to 12-months. Nine services had recent MoC changes: two recently ceased PARS, and seven had decreased long-term review timepoints. RMH review patients at more timepoints and for a longer period than any other health service.
RMH PARS did not review the majority of hip and knee replacements completed in 2023. Benchmarking suggests that RMH could streamline the number of times patients are reviewed in PARS, targeting patients within the first year after surgery and reducing longer-term review. There is significant variability in MoC across Victoria, with recent evolution across most health services.
With an increasing burden of hip and knee joint replacements there is a growing role for PARS. Increased throughput to PARS may lead to further cost savings and improved standardised care. Further research should consider barriers to increasing referrals to PARS. There is potential to continue developing a sustainable MoC in line with current practice across Victoria. This may lead to improved clinic capacity, enabling improved access, and better utilisation of finite orthopaedic resources. Evaluating patient complications and other outcomes may provide further insights when developing PARS MoC.
knee and hip replacement
advanced practice physiotherapy
