All patients who undergo primary partial knee replacement, total knee replacement, total hip replacement, revision total knee replacement, and revision total hip replacement.

This hospital has established a joint arthroplasty care unit integrating the specialists of orthopedics, nursing, rehabilitative medicine, anesthesia, nutrition, traditional Chinese medicine, radiology, pharmacy and social work. With Minimal Invasiveness, Smart Technology, Painless Technique, Safety, Case Management and Fast Recovery in mind, this multi-disciplinary team builds patient-centered resource integration model to provide integrated care throughout the process of pre-admission, hospital stay and post-discharge using case management model. Beginning with out-patient clinic visit, patients are invited into the decision-making process for patient involvement as an integral process in comprehensive pre-operative assessment and post-discharge monitoring. For surgical operation, the intervention is complemented with the programs to speed up recovery. Smart system facilitating: smart drug delivery and clinical support decision-making system for fall prevention. Multi-faceted care encompassing early rehabilitation, multi-modality pain care (modern medicine, traditional Chinese medicine, laser acupuncture), and discharge preparation service. The team takes the health and wellness of the people in remote areas to the heart, and offers holistic, integrated arthroplasty care.

• Individualized joint replacement care pathways with preoperative assessment of nutritional and medical status

• Implementation of shared decision-making (SDM), recognized by patients and professional teams

• Nurse case manager–led coordination providing integrated, continuum care

• Comprehensive integrated inpatient care for joint replacement

• Enhanced Recovery After Surgery (ERAS) to reduce pain and promote functional recovery

• Nurse–patient collaborative medication verification to enhance medication safety

• Use of Clinical Decision Support Systems (CDSS) to reduce postoperative complications through smart nursing

• Data-driven management using Power BI to continuously monitor care quality

• Integration of traditional Chinese medicine (laser acupuncture) after total knee replacement, reducing pain by 55%

• Discharge planning services in collaboration with Yunlin County Government for integrated care

• Since its establishment in 2022, the team has accumulated a total of 219 cases as of August 31, 2024 (an average of 6.84 cases per month).

• The implementation rate of Shared Decision Making (SDM) is 100%. In 2020, the team received the Excellent Team Award in the Clinical Application Group of the " Shared Decision Making (SDM) Practice Campaign" from the National Health Insurance Administration.

The average length of stay for joint replacement surgery (Primary) was 6.2 days in 2021, 6 days in 2022, 5.6 days from January to May 2023, and 5.4 days from July 2023 to August 2024.

Nursing Quality Indicators (Jul 2023–Aug 2024)

Emergency equipment accuracy 99.6% (100%); defibrillator 100% (100%); fall prevention for high-risk patients 99.9% (98%); nursing record completeness 99% (92%); CVC assistance accuracy 100% (100%); CPR accuracy 100% (95%); patient identification 99.7% (100%); daily pain assessment 95.9% (95%); discharge fall education 96.6% (80%); transfer handover 96.2% (96%).

Adverse events: pressure injury 0.01% (≤0.15%); falls 0.001% (≤0.02%); pipeline events 0.003% (≤0.02%); medication errors 0.

2.Joint Replacement Quality Indicators

90-day deep infection, wound infection, and unplanned reoperation: 0%. Preoperative education, timely prophylactic antibiotics (≤60 min), ≤24-hour antibiotic use, and case management: all 100% (antibiotic ≤24h: 98.6% in 2022).

30-day readmission: 0% (1.30% in 2022)

From Nov 2022 to Aug 2024, 153 patients/families completed a 5-point satisfaction survey; all items averaged >4 points.

• 2020: Awarded the Excellence Award, Clinical Application Group, in the Shared Decision-Making (SDM) Practice Campaign by the Joint Commission of Taiwan

• 2020: Received the Silver Award from the International Osteoporosis Foundation (IOF) for Fracture Liaison Service (FLS)

• 2024: Awarded the Silver Award at the Taiwan Sustainability Action Awards (TSAA)

• 2025: Selected by Commonwealth Magazine as a Featured Hospital for Joint Replacement Surgery

With the initiative “Bridging Urban–Rural Gaps, Continuous Joint Care,” we participated in the 4th Taiwan Sustainability Action Awards (TSAA) in 2024, organized by the Taiwan Institute for Sustainable Energy (TAISE), and received Silver Awards for SDG 10 (Reduced Inequalities) and SDG 3 (Good Health and Well-being).