Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team

Arana, Melissa; Harper, Licia; Qin, Haili; Mabrey, Jay D.

doi:10.1097/nor.0000000000000366

Cited by 15 publications

(20 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Due to government-mandated programs, bundled payments and accountable care organizations (ACOs) stakeholders must provide high-quality coordinated care to control costs. Therefore, both payers and providers are increasingly interested in the study of outcomes, which would include decreasing prosthetic joint infections and LOS (Arana, Harper, Qin, & Mabrey, 2017).…”

Section: Problem Statementmentioning

confidence: 99%

“…The THAs and TKAs have become increasingly popular orthopedic procedures, with expected increases of 174% and 673% by the year 2030 (Kurtz et al, 2014). An estimate for 2050 is 1,859,553 cases for THAs and 4,174,554 cases for TKAs (Arana et al, 2017).…”

Section: Total Joint Arthroplastymentioning

confidence: 99%

“…The demand for total hip and knee joint replacements continue to rise steadily. An estimate for 2050 is 1,859,553 cases for total hip arthroplasties (THAs) and 4,174,554 cases for total knee arthroplasties (TKAs) (Arana et al, 2017). THAs and TKAs have become increasingly popular orthopedic procedures, with expected increases of 174% and 673% by the year 2030 (Kurtz et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…The demand for THA and TKA procedures is rising rapidly due to the aging population and the prevalence of arthritis (McCann-Spry et al, 2016). As these numbers increase, insurers continue to push for lower costs and better outcomes (Arana et al, 2017). PJIs and LOS are two of the outcomes that I evaluated in this study.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evaluating the effects of a total joint education class on patient outcomes

Marshall¹

2020

Journal of Orthopaedics

View full text Add to dashboard Cite

Section: Problem Statementmentioning

confidence: 99%

Section: Total Joint Arthroplastymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluating the effects of a total joint education class on patient outcomes

Marshall¹

2020

Journal of Orthopaedics

View full text Add to dashboard Cite

“…In total, 54 studies, reported in 55 articles, met the inclusion criteria. 57,58,67,71,74,[81][82][83][84]86,91,96,97,100,[104][105][106]109,110,112,115,116,[119][120][121]123,125,131,133,134,145,146,151,159,162,166,179,183,184,186,210,211,215,[222][223][224]232,244,256,257,…”

Section: Study Selectionmentioning

confidence: 99%

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

Nunns

Shaw

Briscoe

et al. 2019

Health Serv Deliv Res

View full text Add to dashboard Cite

Background Elective older adult inpatient admissions are increasingly common. Older adults are at an elevated risk of adverse events in hospital, potentially increasing with lengthier hospital stay. Hospital-led organisational strategies may optimise hospital stay for elective older adult inpatients. Objectives To evaluate the effectiveness and cost-effectiveness of hospital-led multicomponent interventions to reduce hospital stay for older adults undergoing elective hospital admissions. Data sources Seven bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database) were searched from inception to date of search (August 2017), alongside carrying out of web searches, citation searching, inspecting relevant reviews, consulting stakeholders and contacting authors. This search was duplicated, with an additional cost-filter, to identify cost-effectiveness evidence. Review methods Comparative studies were sought that evaluated the effectiveness or cost-effectiveness of relevant interventions in elective inpatients with a mean or median age of ≥ 60 years. Study selection, data extraction and quality assessment were completed independently by two reviewers. The main outcome was length of stay, but all outcomes were considered. Studies were sorted by procedure, intervention and outcome categories. Where possible, standardised mean differences or odds ratios were calculated. Meta-analysis was performed when multiple randomised controlled trials had the same intervention, treatment procedure, comparator and outcome. Findings were explored using narrative synthesis. Findings A total of 218 articles were included, with 80 articles from 73 effectiveness studies (n = 26,365 patients) prioritised for synthesis, including 34 randomised controlled trials conducted outside the UK and 39 studies from the UK, of which 12 were randomised controlled trials. Fifteen studies included cost-effectiveness data. The evidence was dominated by enhanced recovery protocols and prehabilitation, implemented to improve recovery from either colorectal surgery or lower limb arthroplasty. Six other surgical categories and four other intervention types were identified. Meta-analysis found that enhanced recovery protocols were associated with 1.5 days’ reduction in hospital stay among patients undergoing colorectal surgery (Cohen’s d = –0.51, 95% confidence interval –0.78 to –0.24; p < 0.001) and with 5 days’ reduction among those undergoing upper abdominal surgery (Cohen’s d = –1.04, 95% confidence interval –1.55 to –0.53; p < 0.001). Evidence from the UK was not pooled (owing to mixed study designs), but it echoed findings from the international literature. Length of stay usually was reduced with intervention or was no different. Other clinical outcomes also improved or were no worse with intervention. Patient-reported outcomes were not frequently reported. Cost and cost-effectiveness evidence came from 15 highly heterogeneous studies and was less conclusive. Limitations Studies were usually of moderate or weak quality. Some intervention or treatment types were under-reported or absent. The reporting of variance data often precluded secondary analysis. Conclusions Enhanced recovery and prehabilitation interventions were associated with reduced hospital stay without detriment to other clinical outcomes, particularly for patients undergoing colorectal surgery, lower limb arthroplasty or upper abdominal surgery. The impacts on patient-reported outcomes, health-care costs or additional service use are not well known. Future work Further studies evaluating of the effectiveness of new enhanced recovery pathways are not required in colorectal surgery or lower limb arthroplasty. However, the applicability of these pathways to other procedures is uncertain. Future studies should evaluate the implementation of interventions to reduce service variation, in-hospital patient-reported outcomes, impacts on health and social care service use, and longer-term patient-reported outcomes. Study registration This study is registered as PROSPERO CRD42017080637. Funding The National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Improving the Pediatric Floor Discharge Process Following Tonsillectomy

et al. 2021

View full text Add to dashboard Cite

Objectives/Hypothesis Over 300,000 tonsillectomies are performed nationwide every year. In 2017, half of children undergoing tonsillectomy at our institution were admitted to the pediatric floor, with only 10.4% being discharged before 11 AM on postoperative day 1 (POD1). Our primary objective was to increase the percentage of patients discharged before 11 AM on POD1 to at least 50% within 1 year. Study Design Prospective observational (quality improvement). Methods A multidisciplinary quality improvement (QI) team was assembled. The primary outcome was “timely discharges,” defined as percentage of patients discharged before 11 AM on POD1; secondary outcomes were percentage of patients discharged before 1 PM and mean length of stay (hours). Seven‐day readmission rate served as our balancing measure. Prior year data served as baseline. A process map, Ishikawa diagram, and Pareto chart were utilized to identify specific target areas for improvement. Key interventions included announcement of our initiative, an electronic health record‐based handoff text prompt, discharge checklist, automated discharge instructions, encouragement to place discharge orders by 9 AM and implementation of early POD1 rounds. Data were collected on a biweekly basis and the primary and secondary outcomes were plotted on control charts and analyzed using rules for special cause variation. Results Within 12 months, POD1 discharges before 11 AM and before 1 PM increased to 44.9% and 83.8%, respectively, with sustained improvement for the first 6 months of the subsequent year. Mean length of stay decreased, and 7‐day readmission rates were unchanged. Conclusions By understanding the factors influencing timely POD1 discharges after tonsillectomy, key interventions were implemented to achieve an increase in timely discharges. Level of Evidence 3 Laryngoscope, 132:225–233, 2022

show abstract

Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team

Cited by 15 publications

References 14 publications

Evaluating the effects of a total joint education class on patient outcomes

Evaluating the effects of a total joint education class on patient outcomes

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

Improving the Pediatric Floor Discharge Process Following Tonsillectomy

Contact Info

Product

Resources

About