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Creating a Limited Stay Total Joint Program

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Rapid Recovery in Total Joint Arthroplasty

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Abstract

Outpatient total joint replacement is safe and economical when done in the setting of a comprehensive program. A successful outpatient episode of care demands a consistent and measurable sequence of events that integrates all preoperative, operative, and postoperative elements and requires a program that prioritizes an efficient and streamlined approach focusing on standardization, communication, staff training, and infrastructure. Such a program must begin with measurable patient engagement, which will need to be operationalized across the entire episode of care.

Important information is derived from patient engagement and shared decision-making that is critical for determining the appropriate site of care. This information also helps ensure ideal anesthesia, surgical techniques, and postoperative pain control. For optimal utility, such information should be housed within a platform that allows for individualized and efficient intraoperative and postoperative care. This type of platform can save costs in the operating room (OR) by employing evidence-based protocols without sacrificing surgeons’ preferences and techniques; it can also help individualize and facilitate discharge planning, as well as provide online tools for home care monitoring and real-time notifications. This approach will help avoid “failures to launch,” especially when integrated with preventative measures for issues such as urinary retention and nausea. Ultimately, the information collected can be modeled and used for meaningful quality review and improvement.

The principles of patient engagement, patient registration, and shared decision-making certainly contribute to better care. In this world of value-based care, these principles are becoming essential and integral parts of bundled payment and other alternative payment methods.

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Author information

Authors and Affiliations

  1. Department of Orthopedics, The Everett Clinic, Kirkland, WA, USA

    Craig McAllister

  2. Department of Orthopedics, LSU Health Sciences Center, New Orleans, LA, USA

    Vinod Dasa, Brandon Kent & Michael Langley

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  1. Craig McAllister
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  2. Vinod Dasa
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  3. Brandon Kent
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  4. Michael Langley
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Editor information

Editors and Affiliations

  1. Northwell Orthopedic Institute, New York, NY, USA

    Giles R. Scuderi

  2. The Orthopaedic Center of New Jersey, Somerset, NJ, USA

    Alfred J. Tria

  3. Hospital for Special Surgery, New York, NY, USA

    Fred D. Cushner

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McAllister, C., Dasa, V., Kent, B., Langley, M. (2020). Creating a Limited Stay Total Joint Program. In: Scuderi, G., Tria, A., Cushner, F. (eds) Rapid Recovery in Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-41223-4_4

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