Relias Media - Continuing Medical Education Publishing

The trusted source for

healthcare information and

CONTINUING EDUCATION.

  • Sign In
  • Sign Out
  • MyAHC
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • Subscribe Now
      • My Subscription
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    Home » Total joint replacement patients need care coordination, too

    Total joint replacement patients need care coordination, too

    January 1, 2015
    No Comments
    Reprints
    Facebook Twitter Linkedin Share Share

    Related Articles

    Case Managers Assist With Total Joint Care Transition

    Patients learn about joint replacement process

    Study: Total Knee Replacement Surgery Patients Who Live Far From Hospital Experience Better Outcomes

    Related Products

    Some Joint Replacement Patients May Go Home the Same Day as Surgery

    Improving Care Coordination for Substance Abuse Patients

    Care coordination model works well with diabetes patients

    Keywords

    case management

    Outcomes Management

    Total joint replacement patients need care coordination, too

    Executive Summary

    Joint replacement surgery may seem routine, but patients are being readmitted to the hospital for a variety of reasons, including comorbidities, poor outcomes from therapy, and deep venous thrombosis. Experts recommend the following:

    • Develop triggers for a medical consultation for patients who have chronic conditions and comorbidities or otherwise are at risk.

    • Take all of the patient’s conditions into consideration when developing a discharge plan.

    • Make follow-up phone calls to patients to ensure that they have any prescribed equipment, are participating in physical therapy, have follow-up doctor’s appointments, and are taking their medication.

    Many are older, with comorbidities

    Case managers shouldn’t be complacent about patients receiving total knee and total hip replacement surgery and think that their chances of being readmitted are low, says Brian Pisarsky, RN, MHA, ACM, senior managing consultant at Berkeley Research Group and Centers for Medicare & Medicaid Services (CMS) alumni faculty for the Community-based Care Transitions Program (CCTP).

    "I see data that shows that readmissions for total hips and knees are pretty high. Some are coming back because they didn’t get adequate therapy after discharge or they didn’t do well with therapy. Others come back because of comorbidities, surgical-site infections, deep venous thrombosis, or because they didn’t follow their treatment plan," he says.

    Pisarsky cited statistics that show that 5.5% of total knee and total hip replacement patients come back within 30 days.1

    The readmission rates may not seem high compared to other diagnoses such as congestive heart failure or pneumonia, Pisarsky points out. "However, hospitals and case managers are surprised when they look at their internal data and find that their perceived very low rate is higher than the published CMS overall rate," he says.

    Joint replacement patients frequently are older, sicker individuals who have multiple comorbidities and are readmitted from a skilled nursing facility or assisted living facility during their initial recovery, Pisarsky says. Many times, it’s the medical comorbidities, not the joint replacement that brings them back, he adds.

    "One problem is that joint replacement patients are often admitted and managed by their orthopedic surgeon without medical consultation. However, they may have medical comorbidities such as diabetes, heart failure, or hypertension that need medical management," he says.

    According to Pisarsky, the best practice is to place triggers for medical consultation either in the patient’s clinical pathway or postoperative order sets. "This hopefully will prevent readmissions because of medical comorbidities," he says.

    Look at the entire picture of the patient and not just the surgery, Pisarsky advises. If the patient has chronic conditions, take that into consideration when you anticipate the patient’s needs after discharge.

    Timely follow-up with a primary care physician as well as their surgeon is important for joint replacement patients, he says. Try to get these appointments made prior to discharge from the hospital, he adds.

    Call joint replacement patients a few days after discharge to find out how they are doing and if they are following their treatment plan. Ask if they have started therapy and if they have a follow-up appointment with their surgeon and with their primary care physician, Pisarsky says

    If their doctor ordered a passive range of motion machine, find out if it has arrived and if they are using it, he says. Make sure they are taking whatever medication their doctor prescribed for deep vein thrombosis. If their physician ordered compression hose, make sure they have gotten them and are wearing them as directed.

    "Sometimes patients don’t participate in physical therapy postoperatively and many times complications can arise causing readmissions. It is part of the case manager’s role to encourage them to complete their entire treatment regimen and follow their discharge plan," he says.

    Reference

    1. Procedure Specific Readmission Measures Updates and Specifications Report: Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty. Version 3.0. http://www.qualitynet.org.

    Post a comment to this article

    Report Abusive Comment

    www.reliasmedia.com

    Hospital Case Management

    View PDF
    Hospital Case Management 2015-01-01
    January 1, 2015

    Table Of Contents

    Hospitals are still struggling with reducing readmissions

    Five more ways to improve readmissions, according to the experts

    Total joint replacement patients need care coordination, too

    What home health nurses want from you

    Team effort reduces readmission rate by 20% in two years

    Hospitals, Council on Aging partner to reduce readmissions

    Assessing patients’ functional status to identify risks for readmission

    Begin Test
    Buy this Issue/Course

    Shop Now: Search Products

    • Subscription Publications
    • Books & Study Guides
    • Webinars
    • Group & Site
      Licenses
    • State CME/CE
      Requirements

    Webinars And Events

    View All Events
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • Subscribe Now
      • My Subscription
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    • Help
    • Search
    • About Us
    • Sign In
    • Register
    Relias Media - Continuing Medical Education Publishing

    The trusted source for

    healthcare information and

    CONTINUING EDUCATION.

    Customer Service

    customerservice@reliasmedia.com

    U.S. and Canada: 1-800-688-2421

    International +1-404-262-5476

    Accounts Receivable

    1-800-370-9210
    ReliasMedia_AR@reliasmedia.com

    Mailing Address

    • 1010 Sync St., Suite 100
      Morrisville, NC 27560-5468
      USA

    © 2021 Relias. All rights reserved.

    Do Not Sell My Personal Information  Privacy Policy  Terms of Use  Contact Us  Reprints  Group Sales

    For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, DPO@relias.com

    Design, CMS, Hosting & Web Development :: ePublishing