EFFECTS OF DISCHARGE PLANNING ON LENGTH OF STAY IN PATIENTS UNDERGOING PRIMARY TOTAL KNEE ARTHROPLASTY

Abstract

Abstract Extended hospitalizations for non-medical reasons are a contributing factor to the rising health care costs in the United States. Length of stay after elective orthopaedic surgery is highly variable and often prolonged unnecessarily due to lack of coordinated care. The project setting was a rural regional trauma center in a Midwestern state. Discharge assessment tools and early discharge planning have demonstrated promising results at optimizing organizational resources and reducing length of stay. The purpose of this pilot, quality improvement project was to implement a discharge risk assessment tool and discharge planning, prior to admission for patients undergoing elective, primary total knee arthroplasty and evaluate the impact on hospital length of stay in the orthopaedic surgery population. The project setting was a rural regional trauma center in a Midwestern state. The organization did not use a discharge assessment tool for orthopaedic surgical patients and had inconsistent, prolonged length of stay with multiple barriers to a hospital discharge. The project implemented the Blaylock Risk Assessment Screening Score (BRASS) prior to admission, at the pre-anesthesia testing visit. The BRASS has consistently demonstrated validity and reliability of predicting patient’s disposition at discharge. Patients who obtained a BRASS score greater than 20 were referred to the outpatient social worker for probable skilled nursing placement upon discharge. The collaborating outpatient social worker began discharge planning and coordination of discharge needs before and during hospital admission, guided by the BRASS results. Data was collected on a group of 10 patients and matched to 10 control patients through a retrospective chart review. The control group was selected after the intervention to allow case-control matching and minimize confounding variables. Controls were matched based on age, gender, and BRASS results. Data collection included: age, gender, ethnicity, co-morbidities, smoking status, attendance of pre-operative joint education class (within 30 days or longer), post-operative complications, discharge disposition, length of stay, and accuracy of BRASS prediction in the intervention group. Length of stay was compared, and resulted in over 80% of the intervention group being discharged by post-operative day two; reduced from 60% being discharged on post-operative day three in the control group. Further qualitative data provided insight to the patient population undergoing primary total knee arthroplasty in the organization. The project demonstrated a significant cost-savings strategy for the organization and enhanced patient care and coordination using a discharge assessment tool and proactive discharge planning. Keywords: discharge planning, length of stay, discharge assessment tool, Blaylock Risk Assessment Screening Score (BRASS)