Post-acute Transitional Journey: Caring for Orthopedic Surgery Patients in the United States

Abstract

As the geriatric population in the United States continues to age, there will be an increased demand for total hip and total knee arthroplasties (THAs and TKAs). Older patients tend to have more comorbidities and poorer health, and will require post-acute care (PAC) following discharge. The most utilized PAC facilities following THA and TKA are skilled nursing facilities (SNFs), in-patient rehabilitation facilities (IRFs), and home with home health care (HHC). Coordination of care between hospitals and PACs, including the complete transfer of patient information, continues to be a challenge which impacts the quality of care provided by the PACs. The increased demand of hospital resources and PACs by the geriatric population necessitates an improvement in this transition of care process. This review aims to examine the transition of care process currently utilized in the United States for orthopedic surgery patients, and discuss methods for improvement. Employing these approaches will play a key role in improving patient outcomes, decreasing preventable hospital readmissions, and reducing mortality following THA and TKA. The extensive nature of this topic and the ramification of different types of healthcare systems in different countries were the determinant factors limiting our work.

Innovation in Orthopedics: Part 1—Design Thinking

“…Clinical redesign understand, define, and improve clinical processes that underpin the patient journey across the continuum of care, promoting collaborative team-based care models and the adoption of emerging technologies to improve efficiency [ 45 , 46 ]. In the orthopedic journey, experiences transcend clinical and hospital environments, and patients may be suitable for early discharge to home with appropriate support services, including education for patients and caregivers, or may be discharged to inpatient rehabilitation facilities to allow for more advanced medical care [ 47 ]. During rehabilitation, design thinking contributes to improving individual’s ability to actively live a healthy lifestyle [ 48 ]; for example, to transform physical therapy into game play and art creation, gesture-based interactive platforms have been developed [ 49 ].…”

“… Understanding the nature of problems : design, as the science of the artificial [ 58 ], is well-suited for approaching complex problems, yet it is of little use when solving well-defined problems. Design thinking initiatives are human-centered, such as designing for an aging population, that will be more functionally dependent [ 59 ], demanding initiatives to maintain the physical capacity [ 60 ], with greater probability of accessing healthcare services [ 47 ], considering the need for “social distancing” caused by the COVID-19 pandemic that complicates traditional care model for recovery after medical procedures that demand intensive physical therapies [ 37 ]. Moreover, to align current and future services, new models of care need to be developed, to ensure that the right care is delivered at the right time by the most appropriately trained health professional and at a reasonable cost [ 4 , 17 ].…”

Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society

“…For example, members of the care team, such as orthopedic surgeons who usually attend patients in the acute setting, usually do not have a physical presence in PAC facilities. 18 The majority of patients require some form of PAC after a hip fracture. 10 Postacute care may be delivered at home (including senior living centers and assisted living facilities) with physical therapists and nurses, in a skilled nursing facility or, in complicated cases, an inpatient rehabilitation hospital.…”

“…For example, members of the care team, such as orthopedic surgeons who usually attend patients in the acute setting, usually do not have a physical presence in PAC facilities. 18 …”

Postacute Care Disposition for Total Hip and Total Knee Replacement Surgery for Asian Americans

“…A review of literature on transitioning patients from the hospital post-TKA and post-THA found that home health patients had fewer complications compared with patients transferred to postacute facilities. 32 Haghverdian et al (2017) noted that a lack of continuity of PT during the transition from hospital to skilled nursing facility (SNF) led to reduced functionality, while Mallinson et al (2014) found that none of the types of postacute care (inpatient rehabilitation facilities [IRFs], SNFs, and HHC) exhibited an advantage over the other in terms of self-care and functionality when the total LOS in post-acute care (PAC) was controlled for. 33,34…”