Reducing Length of Stay and Hospital Readmission for Orthopedic Patients: A Quality Improvement Project.

Abstract

Transitioning patients from the hospital to home after a total hip or knee arthroplasty is challenging. Severe pain, comorbidities and complex medication regimes have the potential to delay readiness for discharge, increase length of stay (LOS), and cause readmissions. The goal of this practice improvement project was to improve patient readiness for discharge after total joint arthroplasty to reduce LOS, prevent emergency department (ED) visits, and prevent hospital readmissions. This quality improvement project was guided by the Iowa Model and implemented a prepost program implementation evaluation design. Nurses incorporated the Registered Nurse Assessment of Readiness for Hospital Discharge Scale (RN-RHDS) to guide and evaluate discharge education efforts. The focused education cohort demonstrated significantly decreased LOS and decreased readmissions compared to the cohort receiving standard education efforts. ED visits were not significantly different amongst cohorts. This practice improvement project demonstrates successful translation of research into practice. The use of focused education and the RN-RHDS tool is recommended for nursing to improve patient readiness for discharge and patient outcomes.