Case Studies: Successful Hip and Knee Replacement Readmissions Reduction Programs
Gardner has seen great success in reducing the number of hip and knee replacements that result in readmission by performing surveillance on the patient.
“At my care center, there is a physician assistant who tracks and monitors the patients receiving hip and knee replacements, calling to check in on patients’ progress, comfort with prescribed medications, and physical therapy schedule,” he says. “Using a laptop or smart device, patients also have access to a platform where they can submit any symptoms they are experiencing.”
If any submitted symptoms are red flags, the patient would then receive a phone call. He also encourages patients to call him on his cell at any time of day in order to avoid any unnecessary visits to the ER.
“On the front end, we also do everything possible to ensure that the patient receiving surgery is medically optimized to do so,” Gardner says. “In advance, they must go to their primary care doctor to assess their current cardiac, pulmonary, and renal status, and address any other concerns. This ensures avoidable post-surgery risks are minimized.”
Hallstrom says there are sites participating in MARCQI that have staff dedicated to focusing on pain management. This includes early follow-up phone calls from nurse coordinators.
“The intent of these calls is to catch trouble early, assist the patients, and avoid returns to the hospital,” he says. “Other Michigan sites have focused on reducing opioid-related constipation with education and by providing stool softener kits to patients. When patients receive better care, and have better outcomes, there is less opportunity for complications and a need to return to the hospital.”
Leyden says the MARCQI collaborative has engaged in an ongoing effort to improve the quality of care for all patients undergoing hip and knee replacement in Michigan and these efforts succeed because the surgeons, nurses, data abstractors, quality teams, and other participants work together to achieve meaningful quality improvement goals.
The collaboration allows for efforts to continually be refined, driving further progress, which is evident in the results MARCQI has experienced to-date, including 18% reduction in 30-day readmissions; 17% reduction in ED visits within 30 days (hip); 52% reduction in VTE events; and 88% reduction in infections.