Surgeons May Be "Touched Out": The Ever-Increasing Workload of Telephone Calls and Electronic Messages in Total Joint Arthroplasty.

Abstract

Background: With evolving patient expectations and practice models, perioperative communication through telephone and web encounters, termed "touchpoints," gains further importance. This study quantifies the workload created by telephone calls and electronic messages during patient episodes of care and analyzes their change over time.

Methods: We retrospectively reviewed 277,729 telephone calls and 16,966 electronic messages within the 30-day preoperative periods and the 90-day postoperative periods of 45,216 patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from January 1, 2016, to December 31, 2022. Touchpoints were temporally trended by year to characterize utilization over time. Regression analysis was performed to determine factors predictive of increased touchpoint utilization.

Results: Preoperatively, patients had a mean of 2.2 telephone calls (2.2 for THA and 2.1 for TKA) and 2.3 electronic messages (2.3 for both THA and TKA). Postoperatively, patients had a mean of 4.4 telephone calls (4.1 for THA and 4.6 for TKA) and 2.8 electronic messages (2.8 for both THA and TKA). From 2016 to 2022, the total perioperative touchpoints increased by 105% (8.7 to 17.8 touchpoints) for patients who underwent TKA and by 121% (7.3 to 16.1 touchpoints) for patients who underwent THA. Medicare insurance was independently associated with fewer touchpoints compared with commercial insurance (beta estimate, -0.31 [95% confidence interval, -0.41 to -0.21]; p < 0.001).

Conclusions: Practices can now expect to handle a mean of 17.8 touchpoints for patients who undergo TKA and 16.1 for patients who undergo THA. The increase in touchpoint utilization underscores a growing strain on orthopaedic practices' resources as reimbursement for these procedures continues to decrease. Future policy discussions must acknowledge and remunerate the time spent communicating via telephone calls and electronic messages to offset their increasing frequency.

Clinical relevance: As orthopaedic care begins to extend beyond the operating room into patient communication pathways, understanding how the growing touchpoint utilization can strain resources and adversely affect high-quality patient care is essential.