Successfully Transitioning Total Joint Replacement Cases from Inpatient to Outpatient


As described in a recent article published by Becker’s ASC Review, “The number of hip and knee joint replacement surgeries performed in an outpatient setting is expected to grow 73% from approximately 1.1 million today to approximately 1.9 million by 2026.”


Keeping Cases in the Hospital

For now, coronavirus (COVID-19) continues to wreak havoc on total joint replacement (TJR) surgery programs across the country. Many states and health systems are again restricting inpatient elective surgery which is the financial engine for many hospitals. With standardized process mapping and implementation of clinical pathways, outpatient TJR can be safe and effective for many patients.

While total joint replacement surgeries and associated technology have improved over the years, current events could force hospitals to more rapidly shift TJR surgeries to the outpatient setting. COVID-19 has altered perceptions in the surgical suite as to what constitutes a safe surgical environment pushing hospitals to develop innovative ways to adapt and respond to the post-COVID-19 future while keeping cases in the hospital.

Migrating TJR Surgeries Without Losing Cases to ASCs

As one of the biggest components of elective inpatient surgery in many hospitals, Sullivan Healthcare Consultants (SHC) can help you quickly and effectively transition many TJR cases from inpatient to outpatient without losing these cases to an ambulatory surgery center (ASC).

Our perioperative consultants can help you:

  • Change surgeon behaviors.

  • Break down barriers between departments that prevent patients from going home the same day.

  • Work with nursing staff to ensure the right activities are completed at the appropriate times to facilitate discharge.

  • Educate office staff and pre-surgical screening departments about appropriate patient selection and scheduling.

  • Develop a rapid mobilization plan to promote post-op day one patient release.

  • Craft a post-op follow up process.

Essential Elements of a High-Performing Outpatient TJR Program

  • Proper patient selection.

  • Preoperative patient and family education.

  • Perioperative multidisciplinary coordination.

  • Alternatives to opioids/opioid-sparing analgesia.

  • Early and effective post-discharge planning.

“As the push for value-driven health care continues and the incidence of total joint arthroplasty continues to grow, same-day-discharge arthroplasty will likely become more prevalent and increasingly incentivized.” —Alexander M. Crawford, MD, Antonia F. Chen, MD, MBA, Amirmehdi Sabeti, MD, Jean F. Jay, PT, DPT, CLT and Vivek M. Shah, MD, The Journal of Bone and Joint Surgery.

The Leaders in Healthcare Consulting


SHC has the vast experience and breadth of knowledge to help you transition this complex challenge into an opportunity—positioning your hospital for success in a post-COVID-19 world. To learn more about our services and how SHC can help improve your organization’s performance, contact us today.


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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​​Tel: 866-303-8968

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