The Benefits of Shifting TJA Procedures to Same Day Discharge

TJA Blog Series Part II


Shifting total joint arthroplasty (TJA) to an outpatient setting can be both safe and effective. Case prioritization and patient selection are critical to continuing surgeries. Following this plan can be done safely by using risk assessments, gathering the right data to inform decisions, and implementing a strategic TJA & same day discharge (SDD) program. Using a risk prediction tool like The Outpatient Arthroplasty Risk Assessment Score or the Risk Assessment and Prediction Tool, TJA procedures can safely occur in an outpatient setting. Only appropriate TJA patients should be moved to a freestanding surgery center and be discharged on the day of surgery. In fact, strict patient criteria suggest scheduling surgery for patients who can go home on the same day, the young and healthy, with a BMI under 40.


Home services are another way to work towards SDD. Matching patients to an at-home Physical Therapy program is a proactive and creative step to ensuring the best patient outcome. The pre and post-discharge PT consultations should occur outside of the hospital.


Benefits of Shifting Outpatient Surgery

  • Safe and cost effective option for patients.

  • Provides a steady income stream.

  • More available hospital beds for COVID-19 patients.

  • Mitigate postoperative complications.

  • Avoid hospital transfer on the day of surgery, ER visits, or admission to hospital within 90 days of the index surgery.

  • Achieve optimal outcomes after surgery.

Anesthesia’s Role in the SDD


A 2020 article published by JB & JS Reviews delves into anesthesia's role in the SDD, “In recent years, the desire to decrease opioid usage for surgical patients has also bolstered the desire for non-opioid-based anesthetics. A secondary benefit in limiting opioid use and inhalational anesthetics associated with general anesthesia was a drastic decrease in postoperative nausea and vomiting. Although we prefer to use spinal anesthesia for these reasons, it is not absolutely necessary to facilitate same-day discharge. Patients are routinely discharged on the same day as the surgical procedure after having undergone general anesthesia.”


Dual Objectives for Hospitals & ASCs


SHC consultants understand the dual concurrent objectives for hospitals and ASCs and how to implement leading practices efficiently.


1. Don’t cancel surgery: Complete surgery in COVID-19 surge times by leveraging a unique space and creative staffing solutions.

2. Sustain the post-COVID-19 surge: Consistently adhere to leading practices during periods of potentially limited resources while remaining positioned for long-term growth.


How We Can Move You Forward


As value-driven healthcare becomes more prevalent and the demand for TJA continues to grow, SDD arthroplasty is projected to become the norm and increasingly incentivized. With surgeons and anesthesiologists working together in each phase of care, a team-based approach is paramount to realizing an effective SDD for TJAs. With standardized process mapping and implementation, SHC consultants can help you recoup lost revenue.


To learn more about our perioperative and/or ASC services and how SHC can shift appropriate TJR cases to outpatient and achieve SDD, contact us today.


Additional Reading


Randy Heiser is the President of Sullivan Healthcare Consulting. Randy has been a hospital consultant since 1983 and has specialized in perioperative consulting since 1992. He has directed more than 500 surgery department operational improvement studies (and participated in an additional 350) in programs ranging from small community hospitals and freestanding surgery centers to some of the largest university hospitals in the U.S. He was instrumental in the design, development and implementation of the Surgery Benchmark Program that has been used by more than 280 hospitals. He has also participated in the design of several proprietary surgery scheduling information systems currently available in North America.

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