Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the Bundled Payments for Care Improvement Initiative

2018 ◽  
Vol 33 (3) ◽  
pp. 639-642 ◽  
Author(s):  
Omar A. Behery ◽  
Shalen Kouk ◽  
Kevin K. Chen ◽  
Kathleen A. Mullaly ◽  
Joseph A. Bosco ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Skilled Nursing Facility ◽  
Joint Arthroplasty ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Bundled Payments ◽  
Care Improvement

scholarly journals Effects of Skilled Nursing Facility Partnerships on Outcomes Following Total Joint Arthroplasty

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Austin C. Kaidi ◽  
Roshan P. Shah ◽  
Mary G. Doucet ◽  
Alexander L. Neuwirth ◽  
Jeffrey A. Geller ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Skilled Nursing Facility ◽  
Joint Arthroplasty ◽  
Nursing Facility ◽  
Skilled Nursing

A Rapid Recovery Protocol Applied to Total Joint Arthroplasty Reduced Readmissions for Surgical but Not Medical Reasons Over a 5-Year Period

2021 ◽  
pp. 155633162199868
Author(s):  
Justin Turcotte ◽  
Nandakumar Menon ◽  
Jeanne Angeles ◽  
Amina Zaidi ◽  
Paul King ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Hospital Readmissions ◽  
Univariate Analysis ◽  
Skilled Nursing Facility ◽  
Joint Arthroplasty ◽  
Rapid Recovery ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Knee ◽  
Recovery Protocols

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures that are expected to continue increasing in demand. Although they are proven to be safe and effective, emergency room (ER) visits or hospital readmissions within 90 days after these procedures account for more than one-third of the total cost of postacute care. Purpose: We sought to identify changes in reasons for 90-day ER visits and readmissions after total joint arthroplasty (TJA) during a 5-year period over which rapid recovery protocols evolved. Methods: We conducted a retrospective cohort study comparing 1980 patients who had undergone TJA from July 2017 to June 2018 with a previously published cohort of 7466 patients who had undergone TJA from July 2013 to June 2017. All procedures were performed at a single institution. Changes in the proportion of patients returning for medical and surgical reasons were compared using univariate analysis. Results: For patients discharged home, the 2017–2018 cohort showed a significant reduction in the proportion of ER visits due to pain and swelling and wound infection and an increase in visits for medical reasons. This cohort had a higher proportion of readmissions for medical reasons. In patients discharged to a skilled nursing facility (SNF), similar reasons for ER visits were observed across time periods, and a decrease in the proportion of readmissions for wound infections was observed in the 2017–2018 cohort. Falls and nausea, vomiting, or diarrhea increased significantly to account for 9.5% of readmissions each in 2017–2018. Conclusion: The results of a comparison of 2 cohorts demonstrate the heterogeneous and dynamic nature of unplanned return-to-hospital events and the importance of patient support throughout the surgical episode. As we strive toward minimizing ER visits and readmissions after TJA, rapid recovery protocols must continue to evolve to address the complexity of this patient population.

scholarly journals Gait Training in Patients Discharged to a Skilled Nursing Facility Following Total Joint Arthroplasty

2016 ◽  
Vol 7 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Brandon Haghverdian ◽  
David Wright ◽  
Linda T. Doan ◽  
Dennis Tran ◽  
Ran Schwarzkopf
Keyword(s):  
Total Joint Arthroplasty ◽  
Skilled Nursing Facility ◽  
Gait Training ◽  
Joint Arthroplasty ◽  
Nursing Facility ◽  
Skilled Nursing

scholarly journals Skilled Nursing Facility Star Rating, Patient Outcomes, and Readmission Risk After Total Joint Arthroplasty

2018 ◽  
Vol 33 (10) ◽  
pp. 3130-3137 ◽  
Author(s):  
Chloe C. Kimball ◽  
Christine I. Nichols ◽  
Ryan M. Nunley ◽  
Joshua G. Vose ◽  
Jeffrey B. Stambough
Keyword(s):  
Patient Outcomes ◽  
Total Joint Arthroplasty ◽  
Skilled Nursing Facility ◽  
Joint Arthroplasty ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Star Rating ◽  
Readmission Risk

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.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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