{"title":"Patient Satisfaction and Clinical Outcomes Utilizing a Patient Care Coordination Team to Support Same Day Discharge Following Shoulder Arthroplasty.","authors":"Yulia S Lee, Melissa A Wright, Anand M Murthi","doi":"10.1016/j.jse.2025.05.040","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A patient care coordination (PaCC) team has been shown to reduce length of hospital stay and direct costs for total hip and knee replacement patients by coordinating successful same day discharge. There is no prior literature on the impact of a PaCC team on outcomes following shoulder arthroplasty. The aim of this study was to examine factors associated with successful same day discharge utilizing a PaCC team following shoulder arthroplasty, and the relationship of successful discharge to clinical outcomes and patient satisfaction.</p><p><strong>Methods: </strong>This is a single-center retrospective study of all primary total shoulder arthroplasties performed between July 2021 and April 2023 with one of three fellowship trained shoulder and elbow surgeons. All patients were part of the PaCC program. Four subgroups were compared based on demographics, clinical outcome, and patient satisfaction: 1) successful planned same-day discharge (SS), 2) failed planned same-day discharge (SX), 3) successful planned next-day discharge (NN), and 4) failed planned next-day discharge (NX).</p><p><strong>Results: </strong>A total of 497 patients and 515 total shoulder arthroplasty cases were included for analysis. There was a higher ratio of female patients in groups anticipated to be discharged next-day or failed to be discharged same-day compared to those successfully discharged same-day (75.0% SX, 75.4% NN, 69.7% NX vs. 50.9% SS, p < 0.001). The median BMI was higher in groups that failed to be discharged on anticipated dates (29.2 [25.8, 33.9] SS vs. 34.6 [29.6, 41.4] SX, 29.6 [24.2, 35.4] NN vs. 32.1 [29.8, 35.9] NX, p = 0.002). The presence of an active mental health disorder was also higher among patients who failed to be discharged on their anticipated dates (29.6% SS vs. 31.3% SX, 39.3% NN vs. 51.5% NX, p = 0.042). Reoperation rates were highest in the group of patients that failed next-day discharge (12.1% NX vs. 3.3% NN vs. 3.1% SX vs. 1.5% SS, p = 0.009). The rate of ER visits was also significantly higher in groups that failed planned discharge (3.1% SS vs. 6.3% SX, 1.6% NN vs. 15.2% NX, p = 0.012).</p><p><strong>Conclusions: </strong>While there was an overall high rate of successful planned same-day discharge using a PaCC program, female-identifying patients, patients with a higher BMI, and patients with a mental health disorder were at higher risk of failing to discharge as planned. Identifying specific barriers to successful discharge can ensure timely and safe discharge, particularly as practices move towards outpatient shoulder arthroplasty.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; Quality Assessment/Improvement Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Shoulder and Elbow Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jse.2025.05.040","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: A patient care coordination (PaCC) team has been shown to reduce length of hospital stay and direct costs for total hip and knee replacement patients by coordinating successful same day discharge. There is no prior literature on the impact of a PaCC team on outcomes following shoulder arthroplasty. The aim of this study was to examine factors associated with successful same day discharge utilizing a PaCC team following shoulder arthroplasty, and the relationship of successful discharge to clinical outcomes and patient satisfaction.
Methods: This is a single-center retrospective study of all primary total shoulder arthroplasties performed between July 2021 and April 2023 with one of three fellowship trained shoulder and elbow surgeons. All patients were part of the PaCC program. Four subgroups were compared based on demographics, clinical outcome, and patient satisfaction: 1) successful planned same-day discharge (SS), 2) failed planned same-day discharge (SX), 3) successful planned next-day discharge (NN), and 4) failed planned next-day discharge (NX).
Results: A total of 497 patients and 515 total shoulder arthroplasty cases were included for analysis. There was a higher ratio of female patients in groups anticipated to be discharged next-day or failed to be discharged same-day compared to those successfully discharged same-day (75.0% SX, 75.4% NN, 69.7% NX vs. 50.9% SS, p < 0.001). The median BMI was higher in groups that failed to be discharged on anticipated dates (29.2 [25.8, 33.9] SS vs. 34.6 [29.6, 41.4] SX, 29.6 [24.2, 35.4] NN vs. 32.1 [29.8, 35.9] NX, p = 0.002). The presence of an active mental health disorder was also higher among patients who failed to be discharged on their anticipated dates (29.6% SS vs. 31.3% SX, 39.3% NN vs. 51.5% NX, p = 0.042). Reoperation rates were highest in the group of patients that failed next-day discharge (12.1% NX vs. 3.3% NN vs. 3.1% SX vs. 1.5% SS, p = 0.009). The rate of ER visits was also significantly higher in groups that failed planned discharge (3.1% SS vs. 6.3% SX, 1.6% NN vs. 15.2% NX, p = 0.012).
Conclusions: While there was an overall high rate of successful planned same-day discharge using a PaCC program, female-identifying patients, patients with a higher BMI, and patients with a mental health disorder were at higher risk of failing to discharge as planned. Identifying specific barriers to successful discharge can ensure timely and safe discharge, particularly as practices move towards outpatient shoulder arthroplasty.
Level of evidence: Level IV; Case Series; Quality Assessment/Improvement Study.
背景：患者护理协调（PaCC）团队已被证明通过协调成功的当天出院，可以减少全髋关节和膝关节置换术患者的住院时间和直接费用。目前尚无文献报道PaCC团队对肩关节置换术后预后的影响。本研究的目的是利用PaCC团队检查肩关节置换术后成功当日出院的相关因素，以及成功出院与临床结果和患者满意度的关系。方法：这是一项单中心回顾性研究，纳入了2021年7月至2023年4月期间接受过培训的三位肩关节外科医生中的一位进行的所有原发性全肩关节置换术。所有患者都是PaCC项目的一部分。根据人口统计学、临床结果和患者满意度对四个亚组进行比较：1)计划当日出院成功（SS）， 2)计划当日出院失败（SX）， 3)计划次日出院成功（NN）， 4)计划次日出院失败（NX）。结果：共纳入497例患者和515例全肩关节置换术进行分析。预期次日出院组和当日未能出院组的女性患者比例高于当日成功出院组（75.0% SX, 75.4% NN, 69.7% NX vs. 50.9% SS, p < 0.001）。未在预期日期出院组的BMI中位数较高（SS组29.2 [25.8,33.9]，SX组34.6 [29.6,41.4]，NN组29.6 [24.2,35.4]，NX组32.1 [29.8,35.9],p = 0.002）。在未按预期日期出院的患者中，活动性精神健康障碍的存在也更高（29.6% SS对31.3% SX， 39.3% NN对51.5% NX, p = 0.042）。第二天出院失败的患者再手术率最高（12.1% NX vs. 3.3% NN vs. 3.1% SX vs. 1.5% SS, p = 0.009）。计划出院失败组的急诊就诊率也显著更高（3.1% SS vs. 6.3% SX, 1.6% NN vs. 15.2% NX, p = 0.012）。结论：虽然使用PaCC方案的计划当日出院成功率总体较高，但女性患者、BMI较高的患者和有精神健康障碍的患者未能按计划出院的风险较高。确定成功出院的具体障碍可以确保及时和安全出院，特别是当实践转向门诊肩关节置换术时。证据等级：四级；系列;质量评估/改进研究。
期刊介绍：
The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.
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