Can We Reduce the Utilization of Home-Visiting Nurse Services After Primary Total Joint Arthroplasty?

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• 作者：Danielle Y. Ponzio ; MD ; Andrew G. Park ; MD ; Suneel B. Bhat ; MD ; MPhil ; James J. Purtill ; MD
• 关键词：home-visiting nurse services ; rehabilitation ; post&ndash ; acute care ; discharge disposition ; total joint arthroplasty
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：31
• 期：9_supp_S
• 页码：50-53
• 全文大小：188 K

文摘

Home-visiting nurse services (HVNSs) after total joint arthroplasty (TJA) are touted as advantageous compared with inpatient rehabilitation. No study has established the utility of HVNSs compared with discharge home without services.

Methods

A retrospective single-surgeon consecutive series of 509 primary TJA patients compared discharge disposition, length of stay, complications, and patient satisfaction between 2 cohorts. The cohorts were defined by the elimination of routine HVNSs.

Results

Surprisingly, without routine HVNSs, more patients were discharged home (95% vs 88.3% with routine HVNSs) and mean length of stay significantly decreased. Complication rate was similar (2.9% vs 3.9% with routine HVNSs). Patient satisfaction remained favorable. We estimated that eliminating HVNSs avoids excess costs of $1177 per hip and $1647 per knee arthroplasty.

Conclusions

With dramatically diminished HVNS utilization after primary TJA, there was an associated decrease in length of stay and no increase in complication rate suggesting no compromise of patient care with significant cost savings.