Applying Quality Improvement Methods to Decrease Bowel Obstruction Complications After Total Joint Arthroplasty

Abstract

BACKGROUND: Though infrequent, bowel obstruction complications after total joint arthroplasty (TJA) can cause significant patient morbidity and mortality. There are few reports of prevention protocols for these complications in current literature. The purposes of this study were to (1) create a protocol to prevent bowel obstruction complications in TJA patients using the Plan-Do-Study-Act (PDSA) quality improvement model as well as (2) assess the effect of the protocol on the incidence of such complications. METHODS: The protocol was created by a multidisciplinary task force at a single specialty orthopedic hospital. Gastrointestinal complications were monitored after implementation of the protocol. The protocol was continually evaluated for problems and modifications were made as necessary. RESULTS: The protocol was implemented in May 2018. From that time until the end of the year, there was a 31.9% decrease in cases of ileus and no cases of bowel obstruction or perforation were observed. CONCLUSION: Bowel obstruction complications after TJA adversely affect patient outcomes. This study describes a standardized protocol created via the PDSA method of quality improvement that aims to prevent these complications in this patient population through early identification and intervention. Given the growing demand of TJA, future research should focus on further standardization of postoperative care in efforts to improve patient outcomes and reduce healthcare costs.