Establishing a Successful Outpatient Joint Arthroplasty Program

Register, Jennifer L.; Head, Priscilla J.; Orteneau, Germain

doi:10.1002/aorn.12277

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…8 However, there are numerous factors to consider in order to succeed in establishing an out-patient programme, including the presence of a clinical nurse specialist, careful patient selection, pre-operative patient education and specialized protocols. 10…”

Section: Discussionmentioning

confidence: 99%

Day-case pelvic osteotomy for developmental dysplasia of the hip

Moore

Sheridan

Kelly

et al. 2020

Journal of Children's Orthopaedics

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Purpose: In this article we report the results of a pilot study analysing the implications of performing pelvic osteotomies for developmental dysplasia of the hip (DDH) as a day case. We assess the advantages of performing paediatric pelvic osteotomies as day-case procedures from a financial perspective and from an in-patient bed resource point of view. Methods: This was a prospective cohort study analysing Salter and Pemberton pelvic osteotomies performed for DDH over a three-year period from 1st January 2017 to 30th September 2019. All patients residing within 50 km of the hospital were eligible for day-case procedures. All other cases were performed as in-patients. A detailed financial costing analysis was performed and the in-patient resources utilized were documented and compared between the two models of care. Results: In total, 84 Salter and Pemberton osteotomies were performed between 1st January 2017 to 30th September 2019. Of these cases, 35 were performed as day-case procedures. A total reduction in 70 in-patient bed days was reported. Total costs for a single in-patient requiring two nights of admission amounted to €5,752, whereas the discharge cost of a day case was reported at €2,670. The savings made by our institution amounted to €3,082 per day case. A total saving of €102,696 was made over three years. In all, seven day-case patients re-attended due to inadequate pain control. They required overnight admission and were discharged uneventfully the following day. Conclusion: Day-case pelvic osteotomies significantly reduce the number of in-patient bed days used in an elective paediatric orthopaedic setting. Significant financial savings in excess of €3,000 per case are possible. The introduction of day-case pelvic osteotomy procedures can significantly improve the cost-effectiveness of managing DDH provided there are clear protocols in place with close clinical follow-up. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Day-case pelvic osteotomy for developmental dysplasia of the hip

Moore

Sheridan

Kelly

et al. 2020

Journal of Children's Orthopaedics

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“…12 Because many of the primary arthroplasties were performed at outpatient centers and community hospitals, tertiary referral centers across the country have been caring for an increasing number of patients with PJI who underwent index arthroplasty procedures elsewhere. [13][14][15] This study was designed to investigate how such patients with PJI who were transferred were initially triaged and managed at the admitting facility. The results of this study demonstrated that almost all academic medical centers accepted transfer of patients with PJI from other hospitals even if the index arthroplasty procedure was not performed there.…”

Section: Discussionmentioning

confidence: 99%

“…With an increasing number of primary arthroplasties being performed annually, the incidence of revision THA and revision TKA is also expected to increase by 70% and 182%, respectively, by 2030 12. Because many of the primary arthroplasties were performed at outpatient centers and community hospitals, tertiary referral centers across the country have been caring for an increasing number of patients with PJI who underwent index arthroplasty procedures elsewhere 13–15…”

Section: Discussionmentioning

confidence: 99%

Adult reconstruction call and prosthetic joint infection (PJI) management patterns across the United States: a cross-sectional study

Vajapey

Glassman

2021

Current Orthopaedic Practice

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Background:Patients with prosthetic joint infection (PJI) impose a significant burden in total costs, resources consumed, complication rates, and readmission risk. We sought to determine how patients with PJI who were transferred from other hospitals were initially triaged and managed by medical centers across the country. Methods:An online survey was sent to fellowship program directors or chiefs of adult reconstruction (AR) divisions at academic medical centers. The survey consisted of 11 multiple-choice questions regarding initial management and disposition of patients with PJI who were transferred from other hospitals. Statistical analysis was performed. Results:Of 96 programs queried, 34 institutions responded. All participating programs performed revision arthroplasties. Thirty-three (97.5%) of the 34 programs accepted transfer of patients with PJI, even if the index arthroplasty procedure was done elsewhere. Twenty-eight (82.4%) responded that a fellowship-trained AR surgeon provides initial treatment to transferred patients with PJI, provided patients are not septic or critically ill. If a patient was septic or critically ill, 12 (35.3%) programs responded that the surgeon on call for general orthopaedics would provide the initial treatment for PJI, usually with irrigation and debridement with retention of components and that, once the patient is medically stabilized, a fellowship-trained AR surgeon would assume care. Roughly 44% of the programs that participated in the survey had a dedicated AR call pool. Conclusions:There were a variety of models used by academic medical centers for triaging and management of PJI transfer patients. There does not seem to be one single algorithm universally accepted as optimum for initial management of patients.

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“…As a first step, a qualitative needs analysis was performed by reviewing available local resources, surveying practices of a nearby ambulatory surgical centre and conducting a review of all pertinent literature 3 19–25. Pilot cases were performed over a 3-month period to help identify barriers for successful outpatient TJA.…”

Section: Methodsmentioning

confidence: 99%

Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative

et al. 2022

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BackgroundHip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients.MethodsThis was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented.ResultsAfter implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days.ConclusionOur study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.

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Establishing a Successful Outpatient Joint Arthroplasty Program

Cited by 7 publications

References 20 publications

Day-case pelvic osteotomy for developmental dysplasia of the hip

Day-case pelvic osteotomy for developmental dysplasia of the hip

Adult reconstruction call and prosthetic joint infection (PJI) management patterns across the United States: a cross-sectional study

Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative

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