In the United States of America, more than one million total hip replacement surgeries are carried out annually which means that it is one of the most common orthopaedic surgeries carried out currently. It should be noted that the number keeps increasing. The most basic method of taking care of the growing need for inpatient beds is making sure that there is a high hospital turnover (Lei et al., 2021). Additionally, it also reduced the cost of care for not only patients but also hospitals since the cost of in-patient care after total hip replacement surgery is about USD 3,300 per day (Yakkanti et al., 2019). There is evidence that early ambulation in hip replacement patients reduced the length of in-patient hospital stay by up to 4 days. The National Association of Orthopedic Nurses offers a guideline that is used in clinical practice to improve outcomes with the day of surgery mobilization concerning the total joint replacement patient (Lei et al., 2021). Even though the majority of the programs dictate ambulation on the first postoperative day, rarely do programs have the day of surgery mobility as the standard of care (Bristol, 2021). This projected change aims at reporting the effectiveness of education of nursing and physical therapy staff regarding the day of surgery ambulation and the impact it has on patient therapeutic outcomes.
Evidence-based practice is the cornerstone of high-quality care based on the present evidence instead of practice based on tradition. Mackey and Bassendowski (2017) define evidence-based medicine using seven steps. The first step is inquiry whereby a nurse asks a clinical question. As soon as the clinical question is created, there is a need to put it into a PICO (Population, Intervention, Comparison, Outcome) format. The question serves as a framework for carrying out a literature search. For the current change project, the PICO question was:
In the post-operative patients will the day of surgery ambulation against the first post-operation day ambulation led to improved clinical outcomes and reduced hospital stay?
Literature Review
Method of Literature Search
A review of the literature was carried out to identify and collect articles which discussed early ambulation on potential outcomes as well as the use of an education intervention to enhance the acceptance levels of staff of a new practice change. Such databases as CINAHL, Cochrane database, ProQuest, Google Scholar and Google search engines were employed with the help of key words as “joint replacement” OR “orthopaedic” AND “total hip replacement” OR “total knee replacement” OR “arthroplasty” AND “early ambulation” AND “fast-track” AND “mobilization” AND “activity” AND “length of stay” AND “postoperative function” AND “functional indicators” AND ‘discharge destination.” Therefore, the review of literature focused on the early intervention having the length of stay and time during the post-operative ambulation.

Synthesis of Literature
In a study conducted by Yakkanti et al. (2019) among total knee arthroplasty patients to determine the impact of early mobilization on postoperative day 0 (POD 0) on their hospital stay and discharge. The patients were divided into two groups that is POD 0 and POD 1 based on the day that ambulation was carried out. Two groups were compared in terms of length of hospital stay and discharge disposition by employing univariate analysis. The findings of the study showed that there was a significant reduction in the length of hospital stay among the patients that were mobilized on POD 0 in stark contrast to those on POD 1 with patients more mobilized on POD 0 being discharged home. The study answers the PICO question of if early ambulation leads to reduced hospital stay among arthroplasty patients.
Chua et al., 2020 conducted a study with the central focus of finding out if an accelerated mobilization protocol implemented in isolation is linked to decreased length of hospital stay without compromising the quality of care. The study employed a Before-After (Quasi-experimental design). It should be noted that the standard practice before implementation of the new protocol entailed physiotherapist-led mobilization once daily starting on day 1 postoperative. According to the new protocol, patients were required to be ambulated 4 times by the end of Day 2 including an attempt to start on day 0. Poisson regression modelling played a significant role in determining the relationship between the study period and length of stay in the surgical ward. The study findings suggested that a small decrease in length of stay is possible using an early ambulation protocol in isolation following TKA although staff burden is elevated undermining not only sustainability and level of change.
Lei et al. (2021) conducted a study on the effect of early ambulation within 24 hours following unilateral TKA on post-operative rehabilitation among patients in the Chinese population. The study used a cohort of patients with knee osteoarthritis that had been done TKA at 24 large teaching hospitals in the period starting January 2014 and ending November 2016 that involved two groups with one group having undergone ambulating within 24 hours and the next group ambulating in more than 24 hours. The findings of the study showed that the early ambulation group had a reduced length of hospital stay and reduced hospitalization costs as well as pain levels as compared to the late ambulation group.
Agarwala et al. (2020) retrospectively analyzed the outcomes of the Enhanced Recovery After Surgery pathways (EARSp) for the TKA at a tertiary care centre with a major focus on the pre-hospital preparations, in-hospital care, and post-hospital discharge. All the TKA patients which were operated on by the senior author between July 2016 to January 2018 were followed up for a minimum of one year with the outcome measured being a Visual Analogue Score to represent pain at rest and on moving, postoperative complications as well as functional scores. The funding of the study suggested that pain following TKA is of the main stumbling blocks and thereby reducing functional recovering and increasing average LOS.
Bristol (2021) carried out a study to find out if standing or walking before 8-hours post-operative was associated with a decreased overall hospital stay. This is a retrospective chart review which concentrates on 92 randomly selected general anaesthesia patients that have undergone total hip replacement from Nebraska Medicine in Omaha, NE from August 2017 to August 2018. The findings of the study suggested that there is a statistically significant difference between the length of hospital stay for total hip replacement patients that were mobilized before 8 hours of surgery completion compared to those that did not.
Adogwa et al. (2017) conducted a study to evaluate the impact of early mobilization on patient outcomes and rates of readmission 30 days after discharge. An ambispective study of 125 elderly patients that were undergoing surgery to correct degenerative scoliosis. The findings of the study showed that early ambulation following surgery significantly reduced the incidence of perioperative complications and contributes to improved perioperative functional status among elderly patients. This article contributes to the PICO question by providing evidence that early ambulation has positive outcomes among post-operation patients.
Achieving faster ambulation following surgery is a multidisciplinary function. For example, physiotherapists have a key role to play in the multidisciplinary Enhanced Recovery After Surgery (ERAS) team by enhancing early ambulation as well as return to normalcy for the patients.
Pua and Ong (2014) carried out a study to determine the relationship between early ambulation and length of stay, financial burden and desired therapeutic outcomes. The study method used was a retrospective study of 1504 patients that were subjected to total knee arthroplasty between August 20009 and January 2011 in a tertiary caregiving institution. The findings have it that as small as a 1-difference in the day of ambulation caused a major impact on the shortening of the length of stay, reduced hospitalization costs and enhanced knee function.
Li et al., 2019 argue that Enhanced recovery after surgery (ERAS) pathways reduced the length of hospital stay for patients undergoing TKA. The scholars conducted a randomized controlled trial that was prospective, multi-centred and open-(Pua & Ong, 2014)labelled to find out the superiority of the ERAS pathway concerning length of stay for TKA patients compared to non-ERAS clinical practice. The results of the study protocol could provide insights into the clinical uses of the ERAS pathway in TKA.