Impact of integrating Quality Control Circle, Disease-Specific Care Certification and Enhanced Recovery After Surgery on perioperative outcomes in joint replacement.

Abstract

Enhanced Recovery After Surgery (ERAS) programmes improve perioperative outcomes, but real-world adherence varies widely across institutions, limiting their effectiveness. Disease-Specific Care Certification (DSCC) provides governance and standardisation but lacks operational mechanisms for frontline implementation. This study evaluates an integrated Quality Control Circle (QCC) model aligned with DSCC and ERAS protocols to improve perioperative reliability and patient-centred outcomes in joint replacement. A pre-post quasi-experimental study was conducted involving 515 patients undergoing elective total joint replacement. A multidisciplinary QCC team employed root-cause analysis, Pareto prioritisation and iterative Plan-Do-Study-Act cycles to refine processes. DSCC governance principles were used to structure standardised pathways, unify documentation and reinforce interdisciplinary communication. Outcomes included ERAS compliance, length of stay (LOS), preoperative discomfort (thirst, dry mouth), unnecessary blood preparation, complications and staff competency. ERAS compliance increased from 80.9% to 100% after implementation. Preoperative thirst (p=0.0156) and dry mouth scores (p=0.0073) improved significantly. LOS decreased from 6.63 to 5.98 days. Unnecessary blood preparation was reduced from 237 units to zero. Staff competency improved across all domains. No increase in postoperative complications or readmissions was observed. Integration of QCC operational tools, DSCC governance and ERAS clinical elements yielded substantial improvements in perioperative reliability, efficiency and patient comfort. The QCC-DSCC-ERAS hybrid model is feasible, scalable and potentially generalisable to other institutions seeking high-reliability perioperative care.