Avoiding Readmissions—Support Systems Required After Discharge to Continue Rapid Recovery?

Edwards, Paul; Levine, Matthew R.; Cullinan, Kevin; Newbern, Gordon; Barnes, C. Lowry

doi:10.1016/j.arth.2014.12.029

Cited by 44 publications

(25 citation statements)

References 16 publications

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“…43 Hospitalists are acutely aware of the need to prevent costly hospital readmissions for their own success and longevity, which may lead them to become less judicious about how they prescribe opioids. [44][45][46] Our findings suggest a delicate balance between the potential benefits and drawbacks of using opioids to improve efficiency. Whereas it is important to provide pain relief to the patient, which can facilitate a discharge or delay time to next hospital admission, using opioids to smooth a difficult discharge may be detrimental to the patient.…”

Section: Discussionmentioning

confidence: 85%

“…We interpreted this as a form of cognitive dissonance . Hospitalists are acutely aware of the need to prevent costly hospital readmissions for their own success and longevity, which may lead them to become less judicious about how they prescribe opioids . Our findings suggest a delicate balance between the potential benefits and drawbacks of using opioids to improve efficiency.…”

Section: Discussionmentioning

confidence: 89%

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The hospitalist perspective on opioid prescribing: A qualitative analysis

Calcaterra

Drabkin

Leslie

et al. 2016

Journal of Hospital Medicine

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Background Pain is a frequent symptom among patients in the hospital. Pain management is a key quality indicator for hospitals and hospitalists are encouraged to frequently assess and treat pain. Optimal opioid prescribing, described as safe, patient-centered and informed opioid prescribing, may be at odds with the priorities of current hospital care, which focuses on patient-reported pain control rather than the potential long-term consequences of opioid use. Objective We aimed to understand physicians’ attitudes, beliefs and practices towards opioid prescribing during hospitalization and discharge. Design In-depth, semi-structured interviews Setting Two university hospitals, a safety-net hospital, a Veterans Affairs hospital, and a private hospital located in Denver, Colorado or Charleston, South Carolina. Participants Hospitalists (N=25) Measurements We systematically analyzed transcribed interviews and identified emerging themes using a team-based mixed inductive and deductive approach. Results Although hospitalists felt confident in their ability to control acute pain using opioid medications, they perceived limited success and satisfaction when managing acute exacerbations of chronic pain with opioids. Hospitalists recounted negative sentinel events which altered opioid prescribing practices in both the hospital setting and at the time of hospital discharge. Hospitalists described prescribing opioids as a pragmatic tool to facilitate hospital discharges or prevent readmissions. At times, this left them feeling conflicted about how this practice could impact the patient over the long term. Conclusions Strategies to provide adequate pain relief to hospitalized patients, which allow hospitalists to safely and optimally prescribe opioids while maintaining current standards of efficiency, are urgently needed.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 89%

The hospitalist perspective on opioid prescribing: A qualitative analysis

Calcaterra

Drabkin

Leslie

et al. 2016

Journal of Hospital Medicine

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“…Successful participation in an OP TKA program requires a similar albeit more rigorous clinical pathway, as previously demonstrated for rapid recovery TKA. 38,39 These elements include careful patient selection along with medical optimization, a preoperative patient education program, documentation and fostering of a strong social support system, an experienced clinical and surgical team, easy access to on-call medical staff, and a supportive surgical/institutional facility. [40][41][42][43] Although emerging data demonstrates OP same-day discharge TKA can be safely performed, a considerable number of Medicare patients are not candidates for OP TKA.…”

Section: Discussionmentioning

confidence: 99%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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The rise of improved perioperative recovery protocols after total knee arthroplasty (TKA) has led to faster, more streamlined hospital stays for many patients. Combined with the implementation of value-based care and bundled payment initiatives, there has been a paradigm shift toward outpatient TKA surgery. This change to practice has been accelerated by recent policy changes enacted by the Center for Medicaid and Medicare Services regarding the removal of TKA as an inpatient only procedure as well as some insurance companies denying preauthorization for inpatient stays after TKA. Our review aims to address the inclusion and exclusion criteria for outpatient TKA consideration, examine the outcomes for outpatient joint replacement surgery, and discuss limitations of widespread adoption for same-day discharges.

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“…Specifically in TJR surgery, ERAS decreases the need for blood transfusions [12], [16], decreases returns to the operating room [12], and reduces 30- and 90-day mortality [12], [13], [15], [17]. Emphasizing an early discharge, these programs help attenuate costs associated with TJRs [24], [25], [26], [27] without correspondingly increasing complications or readmissions [12], [13], [14], [15], [16], [17].…”

Section: Discussionmentioning

confidence: 99%

Do shorter lengths of stay increase readmissions after total joint replacements?

et al. 2017

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BackgroundEnhanced recovery after surgery protocols for total joint replacements (TJRs) emphasize early discharge, yet the impact on readmissions is not well documented. We evaluate the impact of a one-day length of stay (LOS) discharge protocol on readmissions.MethodsWe conducted a retrospective review of all primary TJRs (hip and knee) from April 2014 to March 2015. Patients who had adequate support to be discharged home were categorized into 2 groups, 1-day (n = 174) vs 2-day (n = 285) LOS groups. Patients discharged to rehabilitation were excluded (n = 196).ResultsPatients in the 1 day group were more likely to be younger (61.7 vs 64.8 years, P < .001), be male (56.3% vs 40.4%, P = .001), and have a lower body mass index (30.0 vs 31.4 kg/m2, P = .012). One-day LOS patients had shorter surgical times (79.7 vs 85.6 minutes, P = .001) and more likely had spinal anesthesia (46.0% vs 31.2%, P = .001). The overall 30-day all-cause (2.3% vs 2.5%, P = .591) and 90-day wound-related (1.1% vs 1.1%, P = .617) readmission rates were equivalent between groups.ConclusionsEarly discharge does not increase readmissions and may help attenuate costs associated with TJRs. Further refinement of protocols may allow for more patients to be safely discharged on postoperative day 1.

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Avoiding Readmissions—Support Systems Required After Discharge to Continue Rapid Recovery?

Cited by 44 publications

References 16 publications

The hospitalist perspective on opioid prescribing: A qualitative analysis

The hospitalist perspective on opioid prescribing: A qualitative analysis

Inpatient versus Outpatient Total Knee Arthroplasty

Do shorter lengths of stay increase readmissions after total joint replacements?

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