scholarly journals Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty

2017 ◽  
Vol 10 (3) ◽  
pp. 397-403 ◽  
Author(s):  
T. David Tarity ◽  
Marion M. Swall
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Current Trends ◽  
Discharge Care

Predicting Patient Discharge Disposition After Total Joint Arthroplasty in the United States

2010 ◽  
Vol 25 (6) ◽  
pp. 885-892 ◽  
Author(s):  
Wael K. Barsoum ◽  
Trevor G. Murray ◽  
Alison K. Klika ◽  
Karen Green ◽  
Sara Lyn Miniaci ◽  
...  
Keyword(s):  
United States ◽  
Total Joint Arthroplasty ◽  
Patient Discharge ◽  
The United States ◽  
Joint Arthroplasty ◽  
Discharge Disposition

scholarly journals A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty

2019 ◽  
Vol 8 (3) ◽  
pp. e000664 ◽  
Author(s):  
Lyle Sorensen ◽  
Lori Idemoto ◽  
Janet Streifel ◽  
Barbara Williams ◽  
Robert Mecklenburg ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hip Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Skilled Nursing Facility ◽  
Joint Arthroplasty ◽  
Quality Improvement Intervention ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Hospital Readmission Rate ◽  
Knee And Hip Arthroplasty

Knee and hip arthroplasties vary in cost, quality and outcomes. We developed a Lean quality improvement intervention for knee and hip arthroplasty patients encompassing the recognition, readiness, restoration and recovery phases of care.The intervention included standardised, evidence-based pathways, shared decision making, patient and family member engagement, and transdisciplinary rounding, implemented successively through a series of rapid process improvement workshops. We evaluated the intervention through run charts and time series analysis for 2005–2014. Outcomes included length of stay (LOS), 30-day readmission, discharge disposition, postsurgical complications and patient satisfaction.Included were 4253 total joint arthroplasty procedures, 1659 hip and 2594 knee. LOS decreased from 3.2 to 2.4 days postintervention for both hip and knee patients (p<0.001). The 30-day hospital readmission rate for hip patients decreased from 3.1% (18/576) to 1.1% (5/446, p=0.032) with knee patients unchanged. Discharge to home (vs rehabilitation facility or skilled nursing facility) increased from 72% (415/576) to 91% (405/446) (p<0.001) for hip patients, and from 70% (599/860) to 87% (578/663) for knee patients (p<0.001).Our standardised multifaceted Lean quality improvement programme was associated with reduced LOS, decreased readmission rates and improved discharge disposition in total knee and hip arthroplasty patients.

scholarly journals Immediate Physical Therapy following Total Joint Arthroplasty: Barriers and Impact on Short-Term Outcomes

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Hunter Warwick ◽  
Andrew George ◽  
Claire Howell ◽  
Cynthia Green ◽  
Thorsten M. Seyler ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Length Of Stay ◽  
General Anesthesia ◽  
Total Joint Arthroplasty ◽  
Operative Time ◽  
Joint Arthroplasty ◽  
Short Term ◽  
Start Time ◽  
Discharge Disposition ◽  
Postoperative Length

Background. Recent evidence suggests benefit to receiving physical therapy (PT) the same day as total joint arthroplasty (TJA), but relatively little is known about barriers to providing PT in this constrained time period. We address the following questions: (1) Are there demographic or perioperative variables associated with receiving delayed PT following TJA? (2) Does receiving immediate PT following TJA affect short-term outcomes such as length of stay, discharge disposition, or 30-day readmission? Methods. Primary TJA procedures at a single center were retrospectively reviewed. Immediate PT was defined as within eight hours of surgery. Demographic and perioperative variables were compared between patients who received immediate PT and those who did not. We identified an appropriately matched control group of patients who received immediate PT. Postoperative length of stay, discharge disposition, and 30-day readmissions were compared between matched groups. Results. In total, 2051 primary TJA procedures were reviewed. Of these, 226 (11.0%) received delayed PT. These patients had a higher rate of general anesthesia (25.2% versus 17.8%, p=0.006), later operative start time (13:26 [11:31-14:38] versus 9:36 [8:24-11:16], p<0.001), longer operative time (1.8 [1.5-2.2] versus 1.6 [1.4-1.8] hours, p=0.002), and higher overall caseload on the day of surgery (6 [4-9] versus 5 [4-8], p=0.002). A matched group of patients who received immediate PT was identified. There were no differences in postoperative length of stay or discharge disposition between matched immediate and delayed PT groups, but delayed PT (OR 4.54; 95% CI 1.61-12.84; p=0.004) was associated with a higher 30-day readmission rate. Conclusion. Barriers to receiving immediate PT following TJA included general anesthesia, later operative start time, longer operative time, and higher daily caseload. These factors present potential targets for improving the delivery of immediate postoperative PT. Early PT may help reduce 30-day readmissions, but additional research is necessary to further characterize this relationship.

Does Discharge Disposition After Primary Total Joint Arthroplasty Affect Readmission Rates?

2010 ◽  
Vol 25 (1) ◽  
pp. 114-117 ◽  
Author(s):  
Stefano A. Bini ◽  
Donald C. Fithian ◽  
Liz W. Paxton ◽  
Monti X. Khatod ◽  
Maria C. Inacio ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Readmission Rates ◽  
Discharge Disposition

637 Disparities in Discharge Disposition: A Burn Model Systems National Database Study

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
Stephanie A Mason ◽  
Gretchen J Carrougher ◽  
Karen J Kowalske ◽  
Jeffrey C Schneider ◽  
Dagmar Amtmann ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Model Systems ◽  
System Level ◽  
National Database ◽  
Discharge Destination ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Discharge Care ◽  
Race Ethnicity

Abstract Introduction Previous data suggest that disparities exist in access to inpatient rehabilitation following burn injury. We aimed to characterize the association between patient race/ethnicity and discharge disposition across multiple centers. Methods Data were derived from the prospectively maintained Burn Model Systems national database. All participants admitted to one of five participating centers between 1994 and 2019, who survived to discharge with a known disposition, were included. The relationship between patient characteristics, injury factors and discharge to home, a skilled nursing facility (SNF), or inpatient rehabilitation was modeled using multinomial generalized estimating equations. Pre-specified stratified analyses were conducted to examine effect modification. Results We identified 4395 participants who met inclusion criteria. Participants were 74% White non-Hispanic (n=3269), 18% Black non-Hispanic (n=812), 3% Hispanic (n=122), 0.5% Asian (n=24), and 4% Other (n=168). Most were aged 18–64 years (68%, n=2998). Overall, 79% (n=3585) of participants were discharged home, 12% to inpatient rehabilitation (n=534), and 6% to SNF (n=276). After adjustment for patient characteristics and injury factors, there were no differences in discharge destination by race/ethnicity. However, subgroup analyses demonstrated effect modification by both center and burn size. At 2 centers, Black participants were significantly more likely to be discharged to SNF or inpatient rehabilitation (Center 1 OR 1.98, 95% CI 1.02–3.85; Center 2 OR 2.36, 95% CI 1.07–5.19). Similarly, among all participants with &gt;20% TBSA, Black participants were more likely to be discharged to SNF or inpatient rehabilitation (OR 1.38, 95% CI 1.06–1.81). Across all groups, having insurance was associated with discharge to SNF or inpatient rehabilitation (OR 1.68, 95% CI 1.21–2.33). Conclusions Although no overall difference in discharge destination by race was identified, stratified analyses indicate disparities in discharge disposition at the patient and system level. At specific centers, and among those with &gt;20% TBSA injury, Black participants are more likely to be discharged to SNF and inpatient rehabilitation than other ethnic groups. Applicability of Research to Practice Both patient and system level factors are associated with discharge to higher levels of post-discharge care, suggesting that further characterization of these factors is warranted. Such data can inform interventions and policy changes aimed at ensuring equitable access to appropriate post-discharge care.

Current Trends in Patient-Reported Outcome Measures in Total Joint Arthroplasty: A Study of 4 Major Orthopaedic Journals

2018 ◽  
Vol 33 (11) ◽  
pp. 3416-3421 ◽  
Author(s):  
Matthew P. Siljander ◽  
Kade S. McQuivey ◽  
Adam M. Fahs ◽  
Lisa A. Galasso ◽  
Kevin J. Serdahely ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Total Joint Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Joint Arthroplasty ◽  
Current Trends ◽  
Patient Reported

The Effect of Comorbidities on Discharge Disposition and Readmission for Total Joint Arthroplasty Patients

2017 ◽  
Vol 32 (5) ◽  
pp. 1414-1417 ◽  
Author(s):  
Jakub Sikora-Klak ◽  
Bradley Zarling ◽  
Christopher Bergum ◽  
Jeffrey C. Flynn ◽  
David C. Markel
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Discharge Disposition

The Effect of Discharge Disposition on 30-Day Readmission Rates After Total Joint Arthroplasty

2014 ◽  
Vol 29 (4) ◽  
pp. 674-677 ◽  
Author(s):  
Nicholas L. Ramos ◽  
Raj J. Karia ◽  
Lorraine H. Hutzler ◽  
Aaron M. Brandt ◽  
James D. Slover ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Readmission Rates ◽  
Discharge Disposition

Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications

2017 ◽  
Vol 32 (9) ◽  
pp. S150-S156.e1 ◽  
Author(s):  
Alex Sher ◽  
Aakash Keswani ◽  
Dong-han Yao ◽  
Michael Anderson ◽  
Karl Koenig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Post Discharge ◽  
Same Day Discharge
Sign in / Sign up

Export Citation Format

Share Document