Patient experience in fast-track hip and knee arthroplasty--a qualitative study

Aims and objectives: To explore the lived experience of patients in fast-track primary unilateral total hip and knee arthroplasty from the first visit at the outpatient clinic until discharge.

Background: Fast-track has resulted in increased effectiveness, including faster recovery and shorter length of stay to about two days after hip and knee arthroplasty. However, the patient perspective in fast-track with a median length of stay of less than three days has been less investigated.

Design: A qualitative design.

Methods: A phenomenological-hermeneutic approach was used, inspired by Paul Ricoeur's theory of narrative and interpretation. Eight patients were included. Semi-structured interviews and participant observation were performed.

Results: Three themes emerged: dealing with pain; feelings of confidence or uncertainty - the meaning of information; and readiness for discharge. Generally, the patients were resistant to taking analgesics and found it difficult to find out when to take supplementary analgesics; therefore, nursing staff needed enough expertise to take responsibility. Factors that increased patients' confidence: information about fast-track, meeting staff before admission and involving relatives. In contrast, incorrect or conflicting information and a lack of respect for privacy led to uncertainty. In preparing for early discharge, sufficient pain management, feeling well-rested and optimal use of time during hospitalisation were important.

Conclusion: The study shows the importance of dealing with pain and getting the right information and support to have confidence in the fast-track programme, to be ready for discharge and to manage postoperatively at home.

Relevance to clinical practice: In fast-track focusing on early discharge, there is an increased need for evidence-based nursing practice, including a qualified judgement of what is best for the patient in certain situations. The knowledge should be gleaned from: research; the patients' expertise, understanding and situation; and nurses' knowledge, skills and experience.