Program targeting excess hospital days reduced readmissions after total joint arthroplasty

Readmissions and excess days in acute care significantly decreased after implementation of a program that triaged total joint arthroplasty patients who re-presented after surgery to the appropriate service line and level of care.

A program targeting the postacute care of orthopedic patients led to reductions in readmissions and excess days in acute care, a before-after pilot study found.

Researchers at an urban teaching hospital developed a program to triage total joint arthroplasty patients to the appropriate service line (orthopedic vs. medicine) and level of care (observation vs. inpatient) on re-presentation to acute care within 90 days of surgery. The program emphasized continuity of care with the primary orthopedic surgery team as well as encouraged discharge to home rather than to rehabilitation facilities and more rigorous preoperative optimization. The researchers used data based on prior billing and coding to assess the program's effect on orthopedic excess days in acute care, defined as length of any readmission or observation stays. The target population included total joint arthroplasty patients and revision total joint arthroplasty patients between April 2016 and September 2017 (preimplementation) and between October 2017 and September 2018 (postimplementation). Results were published online on July 22 by the Journal of Hospital Medicine.

A total of 2,662 patients underwent total joint arthroplasty and revision total joint arthroplasty during the preimplementation (n=799) and postimplementation (n=1,863) periods. Twenty-three patients were managed on observation status during the study period. Readmissions decreased from 49 (6.1%) during preimplementation to 37 (2.0%) during postimplementation (P=0.004). In addition, excess days in acute care decreased from 7.75 days to 4.73 days (P=0.005) after implementation of the program. By design, more rehospitalized patients were on the orthopedic surgery service after implementation of the program compared to the preimplementation period (70% [n=49] vs. 35% [n=22]; P=0.028). The total estimated savings during the pilot was $934,455.

Limitations of the study include its retrospective, single-center design as well as the small numbers of readmissions and observation patients, which resulted in a small effect size, the authors noted. “Despite these limitations, this study provides an important look at how an Orthopedic [excess days in acute care] program can decrease readmissions, decrease [length of stay], and improve continuity of care in patients undergoing [total joint arthroplasty],” they wrote.