J Knee Surg 2021; 34(09): 924-929
DOI: 10.1055/s-0039-3402053
Original Article

Use of a Mandatory Clinical Decision Unit Reduces Readmission Rates following Total Joint Arthroplasty

Arthur Manoli III
1   Detroit Medical Center/Wayne State University, Detroit, Michigan
,
Jacob F. Markel
2   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
3   Medical School, Wayne State University, Detroit, Michigan
,
Natalie M. Pizzimenti
4   Orthopaedic Research, The MORE Foundation, Novi, Michigan
,
David C. Markel
3   Medical School, Wayne State University, Detroit, Michigan
5   Department of Orthopaedic Surgery, Ascension Providence Park Hospital, Novi, Michigan
6   Department of Orthopaedic Surgery, The CORE Institute, Novi, Michigan
› Author Affiliations
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Abstract

Readmission penalties have encouraged the implementation of protocols to reduce readmission rates. We hypothesized that by keeping postoperative patients, who return to the emergency department (ED) in a clinical decision unit (CDU) until being evaluated by the orthopaedic team, there would be a reduction in the readmission rate after total joint arthroplasty (TJA) at our institution. Our institution mandated the use of the CDU for all potential orthopaedic TJA readmissions. A retrospective review of prospectively collected data was performed on 365 patients who presented to the ED after either total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients presenting in the year prior to the implementation of the CDU program were compared with patients presenting in the year after implementation. Demographics, length of stay, comorbidities, and 30-day readmission rates were recorded. Additionally, a financial analysis was performed. Overall, for THA and TKA, there were a combined 141 ED visits prior to the implementation of the CDU program and 224 afterward; of these, 40 were readmitted before the CDU program and only 13 were readmitted afterward (p < 0.01). The financial analysis found that the overall 90-day cost for patients in the postoperative period was nearly $800 lower on average (p = 0.027) post-CDU implementation.

During the first year of the CDU project at our institution, we significantly reduced the readmission rates following TJA and demonstrated significant cost saving. This is a Level III, prognostic study.



Publication History

Received: 10 July 2019

Accepted: 10 November 2019

Article published online:
06 January 2020

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