|
What happens when I get discharged from the hospital following surgery?
In the cost-conscious managed care environment, patient's postoperative disposition must be justified. These studies accurately identified and predicted a patient's disposition, thereby expediting their discharge plan and containing cost.
METHODS: The initial prospective study involved 66 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) who were interviewed 2 weeks preoperatively via telephone by 2 orthopaedic nurse specialists. The questionnaire was designed to elicit the patient's functional level, motivational level, mental status, environment support factors, and social support system (SSS). The nurse and patient agreed to a post-hospital discharge plan: home, a skilled care center, or rehab center. Data was then correlated with the actual post-hospital placement. A subsequent study involving 127 patients undergoing THA and TKA, used the predictive factors identified in the first study to preoperatively assign a disposition. This was then correlated with the actual post hospital disposition.
RESULTS: The initial prospective study identified the availability of a SSS as the critical factor determining discharge disposition. 95% with available SSS did go home. The 2 who did not became confused postoperatively and required a rehab center. 100% with no SSS went to a predetermined rehab center. In the second study, 127 patients were interviewed preoperatively. 100% with no SSS available proceeded to the predicted skilled care or rehab center. 66% with available SSS did go home. 34% with an available SSS went to either a skilled care or rehab center. Reasons for a skilled care or rehab center disposition included 9 patients undergoing bilateral THA or TKA, 10 requested these facilities for various personal reasons, and 10 were unable to return home with their available SSS because of the lack of progression with their physical therapy program (i.e. safety issues). The remaining 2 patients had postoperative complications of urinary incontinence and poor wound healing.
DISCUSSION & CONCLUSION: The primary predictive factor in planning a patient's disposition is the presence of a SSS consisting of available relatives or friends. When present, 66% of patients go home. When absent, 100% of patients go to a rehab facility. Exceptions were in hospital complications, personal preference, and unanticipated lack of progression in physical therapy. A secondary predictive factor is whether the patient is having unilateral or bilateral THA and TKA. 100% of patients undergoing bilateral THA and TKA proceeded to a skilled care facility or rehab center.
|
