The Knee’d For Mandatory Preoperative Education Toni Schlais MSNc ACM-RN (schlais@hartford.edu) Julie Szolomayer MSNc RN- BC (jszolomay@hartford.edu) Cherry A. Karl, PhD, RN, C.N.E. (ckarl@hartford.edu)
As of January 1, 2018, Medicare removed elective total knee replacements from the inpatient only list. This change affects hospital length of stay for both Medicare and commercially insured patients scheduled for elective knee replacement resulting in more patients discharging on postoperative day one. With early discharge can come additional complications increasing challenges and occasionally additional hospital stays
INTERVENTION
This quality based improvement project assessed the existing mandatory preoperative total knee educational program at Hospital A for its post operative preparedness and then compared the response to Hospital B which has an optional preoperative education program. Data on
patient age, day of discharge and discharge disposition were analyzed.
OUTCOMES HOSPITAL A HOSPITAL B
14.0 12.0 10.0
QUANTITY
BACKGROUND
PURPOSE
To assess the efficacy of implementing a mandatory preoperative educational program and its impact on the patient’s length of stay.
RECOMMENDATIONS
Due to the small scale of this project it is recommended that more agencies implement this quality improvement project for identification as ‘best practice’ as it affects discharge disposition to home versus skilled nursing facility.
8.0 6.0 4.0 2.0 0.0
Hospital A
Hospital B
Average LOS
2.2
2.3
Discharged Home
13
10
Discharged to Skilled Nursing Facility
2
6
References: Centers for Medicare and Medicaid Services (2017). January 218 update of the hospital outpatient patient prospective payment systems (opps). Retrieved from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10417.pdf
IMPLICATIONS
Implementing mandatory pre-surgical education shows that patients can be discharged earlier to home aiding in cost containment to Medicare and commercial payer plans. This data supports Hospital A’s mandatory preoperative educational intervention and demonstrates an opportunity for Hospital B to make changes within their pre-operative program to return patients home upon discharge.