Changing Patient Expectations Decreases Length of Stay in an Enhanced Recovery Program for THA

Tanzer, Dylan; Smith, Karen; Tänzer, Michael

doi:10.1007/s11999.0000000000000043

Cited by 30 publications

(25 citation statements)

References 12 publications

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“…Reduction in LOS, increased discharge home, and reduction in perioperative complications resulting in readmission or reoperation are likely the result of improvements in preoperative patient optimization, expansion of multimodal analgesia, and patient education before these elective procedures. Interventions in the preoperative period have been shown to be highly successful in reducing LOS and decreasing overall costs of care [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ]. Other advancements in arthroplasty practice, such as improvements in surgical technique, greater understanding of the hip-spine relationship, or utilization of larger femoral heads and dual-mobility components, may also have contributed to the findings observed in this study.…”

Section: Discussionmentioning

confidence: 99%

Home Discharge Has Increased After Total Hip Arthroplasty, However Rates Vary Between Large Databases

DeMik

Carender

Glass

et al. 2021

The Journal of Arthroplasty

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Background There have been significant advancements in perioperative total hip arthroplasty (THA) care and it is essential to quantify efforts made to better optimize patients and improve outcomes. The purpose of this study is to assess trends in discharge destination, length of stay (LOS), reoperations, and readmissions following THA. Methods Patients undergoing primary THA were identified using International Statistical Classification of Diseases and Current Procedural Terminology codes in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and Humana claims databases. Discharge destinations were assessed and categorized as home or not home. Trends in discharge destination, LOS, readmissions, reoperation, and comorbidity burden were assessed. Results In ACS NSQIP, 155,637 patients underwent THA and the percentage of patients discharging home increased from 72.2% in 2011 to 87.0% in 2017 ( P < .0001). In Humana, 84,832 THA patients were identified, with an increase in home discharge from 56.6% to 72.8% ( P < .0001). LOS decreased and proportion of patients with an American Society of Anesthesiologists score ≥3 or Charlson Comorbidity Index ≥2 increased significantly for both home and nonhome going patients. Patients discharged home had a decrease in readmissions in both databases. Conclusion Patients undergoing THA more often discharged home and had shorter hospital LOS with lower readmission rates, despite an increasingly comorbid patient population. It is likely these changes in disposition and LOS have resulted in significant cost savings for both payers and hospitals. The efforts necessary to maintain improvements should be considered when changes to reimbursement are being evaluated. ACS NSQIP hospitals had a larger proportion of patients discharged home and the source of data used to benchmark hospitals should be considered as findings may differ.

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Section: Discussionmentioning

confidence: 99%

Home Discharge Has Increased After Total Hip Arthroplasty, However Rates Vary Between Large Databases

DeMik

Carender

Glass

et al. 2021

The Journal of Arthroplasty

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“…While all interventions have proven beneficial in this population, patient adoption was often met with some hesitation. A consistently proven cornerstone of successful education on care changes has been pre-operative patient expectation setting [5, 14, 24, 29, 30]. This suggests a potential role for pre-operative patient education to further strengthen the effects of telerounding on patient's perception of their care.…”

Section: Discussionmentioning

confidence: 99%

Telerounding Offers High Patient Satisfaction after Total Joint Arthroplasty

Schwartz

Chan

Levy

et al. 2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Research in surgical fields other than orthopedics has demonstrated high patient satisfaction with non-traditional telerounding modalities. Questions/Purposes: We sought to determine patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores of patients who experienced telerounding in the post-operative period after undergoing total joint arthroplasty (TJA). Methods: Fifty consecutive TJA patients were prospectively enrolled to receive telerounding. The patients were divided into two groups based on their satisfaction with telerounding. The HCAHPS scores of the patients who received telerounding were compared with 50 control patients. Results: Overall, the telerounding cohort had a positive reaction to telerounding. Comparing patients who were highly satisfied to those who were dissatisfied with telerounding, younger patients were found to be more frequently satisfied with telerounding. Compared with patients who did not receive telerounding, patients who experienced telerounding rated the hospital higher on a 10-point scale were more likely to recommend the hospital to others, more frequently believed their physicians treated them with courtesy and respect, and more often believed their physicians always listened to them carefully. Conclusion: An overwhelming majority of our patients found telerounding using FaceTime enhanced their care while recovering post-operatively from TJA. Those patients were typically younger and had significantly higher HCAHPS scores, which potentially can enhance the physician-patient relationship. Keywords telerounding. patient satisfaction. hospital consumer assessment of healthcare providers and systems (HCAHPS) scores. total joint replacement HSSJ

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Section: Introductionmentioning

confidence: 99%

“…The perioperative care process around TKA and THA procedures has greatly improved in recent years due to advances in surgical techniques and the introduction of clinical care pathways [ 6 , 7 , 8 ]. Clinical care pathways are directed at preparing the patient for discharge as soon as possible after surgery, without compromising outcomes [ 3 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Smartphone App with an Accelerometer Enhances Patients’ Physical Activity Following Elective Orthopedic Surgery: A Pilot Study

Dijk-Huisman

Weemaes

Boymans

et al. 2020

Sensors

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Low physical activity (PA) levels are common in hospitalized patients. Digital health tools could be valuable in preventing the negative effects of inactivity. We therefore developed Hospital Fit; which is a smartphone application with an accelerometer, designed for hospitalized patients. It enables objective activity monitoring and provides patients with insights into their recovery progress and offers a tailored exercise program. The aim of this study was to investigate the potential of Hospital Fit to enhance PA levels and functional recovery following orthopedic surgery. PA was measured with an accelerometer postoperatively until discharge. The control group received standard physiotherapy, while the intervention group used Hospital Fit in addition to physiotherapy. The time spent active and functional recovery (modified Iowa Level of Assistance Scale) on postoperative day one (POD1) were measured. Ninety-seven patients undergoing total knee or hip arthroplasty were recruited. Hospital Fit use, corrected for age, resulted in patients standing and walking on POD1 for an average increase of 28.43 min (95% confidence interval (CI): 5.55–51.32). The odds of achieving functional recovery on POD1, corrected for the American Society of Anesthesiologists classification, were 3.08 times higher (95% CI: 1.14–8.31) with Hospital Fit use. A smartphone app combined with an accelerometer demonstrates the potential to enhance patients’ PA levels and functional recovery during hospitalization.

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Changing Patient Expectations Decreases Length of Stay in an Enhanced Recovery Program for THA

Abstract: Level III, therapeutic study.

Cited by 30 publications

References 12 publications

Home Discharge Has Increased After Total Hip Arthroplasty, However Rates Vary Between Large Databases

Home Discharge Has Increased After Total Hip Arthroplasty, However Rates Vary Between Large Databases

Telerounding Offers High Patient Satisfaction after Total Joint Arthroplasty

Smartphone App with an Accelerometer Enhances Patients’ Physical Activity Following Elective Orthopedic Surgery: A Pilot Study

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