“Hospital at home” after hip or knee arthroplasty

This case study follows the 5-step process for accessing and using evidence in response to a request from commissioners to support the work of the Musculoskeletal (MSK) programme.

Identify

Using PICO, the scope of the evidence search was defined as:

Population: Adults who have had knee or hip arthroplasty

Intervention: Hospital at Home (HaH)

Comparison: Usual care

Outcomes: Clinical-effectiveness, cost-effectiveness, societal outcomes

Access

A Clinical Effectiveness Programme Officer was asked to conduct the search and report findings.

The following search question was addressed:

“What is the evidence for hospital at home following knee and hip arthroplasty?”

The search strategy involved searching the following databases and websites:

• AMED
• Cochrane Database of Systematic Reviews
• PubMed
• MEDLINE
• EMCARE
• NICE Evidence
• Google Scholar/ Google

The following search strategy was used:

(“hospital at home”) AND (knee OR hip) AND (arthroplasty* OR replacement)

Appraise

The evidence-base for this subject is limited.  Five articles were identified, including a systematic review on HaH in facilitating early discharge for elective orthopaedic surgery, among other conditions.

Apply

Findings were reported in an evidence review.  All papers included in this review suggest that HaH and inpatient care for those recovering from knee or hip arthroplasty are equally effective in terms of clinical outcomes. However, there is insufficient evidence to determine cost-effectiveness.

Share & Manage

The findings of the review were consolidated into an evidence review. To promote the sharing of learning, this review was uploaded to Health Innovation West of England’s Evidence Repository on the Futures NHS platform.