The development and testing of the Predictor of Appropriate Discharge Destination among patients undergoing elective total knee or hip joint arthroplasty

Implementing a discharge process for patients undergoing elective surgery: Rapid review

BACKGROUND

Hospital discharge is a 'vulnerable stage' in care. A delayed, inappropriate or poorly planned discharge increases hazards and costs, inhibiting recovery, and often leading to unplanned readmission. New discharge processes could boost practice, reduce the length of stay, and, consequently, reduce costs and improve patients' quality of life.

AIM

To identify technology based interventions that have been implemented to facilitate a safe and timely discharge procedure after elective surgery, and to describe implementation barriers and facilitators and patient satisfaction.

METHOD

This rapid review followed a restricted systematic review framework, searching Medline, EMBASE, CINAHL, PsychINFO, and ClinicalTrials.gov. for relevant studies published from 2015 to 2021 in English.

RESULTS

Eleven studies were included. Most interventions were machine-learning-based, and only one study reported patient involvement. Effective leadership, team work and communication were stated as implementation facilitators. The main barriers to implementation were: lack of support from leaders, poor clinical documentation, resistance to change, and financial and logistical concerns. None of the studies evaluated patient satisfaction.

CONCLUSIONS

Findings highlight factors that support the implementation of technology based interventions aimed at a safe and timely discharge process following elective surgery. Nurses play an important role in the provision of information, and in the development and implementation of discharge processes.

The Predictive Accuracy of the CareMOSAIC Risk Assessment for Discharge Disposition in Medicare Bundle Patients After Total Joint Arthroplasty

Background

This article evaluates the predictive accuracy of the CareMOSAIC Risk Assessment for discharge disposition in Medicare patients undergoing total joint arthroplasty.

Methods

Retrospectively collected data from a single institution on 499 consecutive Medicare patients who underwent primary total hip arthroplasty or total knee arthroplasty were reviewed. The CareMOSAIC Risk Assessment was completed by each patient during the preoperative period. The CareMOSAIC Risk Assessment scores were calculated via the CareMOSAIC software, and the scores indicate a risk category for each patient as it relates to post–acute care discharge needs.

Results

The CareMOSAIC Risk Assessment with a binary logistic regression area under the receiver operating characteristic curve of 0.798 appears to be a reliable tool for predicting discharge disposition. The assessment had a positive predictive value of 90.0% and negative predictive value of 76.3% for discharge disposition.

Conclusions

The CareMOSAIC Risk Assessment effectively predicts the discharge disposition for Medicare patients undergoing total hip or total knee arthroplasty.

Medicare Total Knee Arthroplasty Patients Need Not Stay 2 Midnights for Full Facility Reimbursement

BACKGROUND

Health care systems are concerned that facility reimbursements will be reduced based on patient length of stay (LOS) of <2 midnights with the removal of total knee arthroplasty (TKA) from the inpatient-only list. The purpose of this study was to evaluate the effect of LOS and postdischarge disposition on facility reimbursement.

METHODS

We evaluated a consecutive series of 470 primary Medicare TKA patients performed at a single institution from 2018 to 2019. We analyzed facility reimbursement based on patient LOS and discharge disposition. Descriptive statistics were analyzed using chi-square test, analysis of variance, and Student t test calculations.

RESULTS

Overall, the facility was fully reimbursed in 401 patients (85%) at a mean of $11,169. The facility received full reimbursement for 323 of 326 (99%) patients with an LOS of <2 midnights who were discharged to home at a mean of $11,156. This reimbursement was significantly (P < .001) higher than patients who had an LOS <2 midnights who were discharged with home health (mean, $9773) or to a facility (mean, $10,095). For those with LOS >2 midnights, there was no difference in mean reimbursement among discharge dispositions ($11,202 vs $11,249 vs $11,085, P = .65).

CONCLUSION

In this study, Medicare TKA patients with LOS <2 midnights were fully reimbursed 99% of the time as an inpatient as long as they are discharged to home without home health or to a rehabilitation facility. Those discharged before 2 midnights who require home health service or inpatient facility are more likely to be reimbursed at a lower penalized rate.

Evaluation of a Multisite Nurse-Led Mobility Plan

OBJECTIVE

The aim of this study was to examine the effect of nurses' mobility plan use on patients' length of stay, discharge destination, falls, physical therapy consults, and nurses' knowledge, attitudes, and beliefs regarding patient mobility.

BACKGROUND

Functional decline due to decreased mobility during hospitalization results in diminished quality of life. Sixty-five percent of older inpatients lose the ability to ambulate during hospitalization and 30% do not regain that capability.

METHODS

Using a quasi-experimental design, nurses' use of a mobility assessment on 4 patient outcome variables was examined before (n = 2,259) and after (n = 3,649) use. Nurses' attitudes, knowledge, and beliefs regarding mobility were also examined.

RESULTS

Positive changes in patient variables occurred. Limited change occurred relative to nurses' knowledge, attitudes, and beliefs.

CONCLUSIONS

Implementing a nurse-led mobility plan enhances therapy resource utilization through identification of appropriate consults and improves patients' discharge home. In addition, nurses' knowledge, attitudes, and beliefs toward patient mobility planning can be positively influenced.