SHM Converge Scientific Abstract ePoster Gallery-Implementing a Hospitalist-Led Co-Management Model for Total Joint Arthroplasty Patients

Pdf Summary

This project describes a hospitalist-led co-management model for total joint arthroplasty (TJA) patients at an academic medical center. The initiative was developed in response to the growing volume and medical complexity of TJA cases, as well as Medicare’s shift toward bundled payments that emphasize quality and efficiency, including shorter length of stay (LOS).<br /><br />The goal was to provide comprehensive inpatient co-management for all postoperative TJA patients and to create a hospitalist-run preoperative clinic for medically complex patients. The ambulatory clinic was designed to assess surgical risk, optimize perioperative medical conditions, and identify opportunities to improve inpatient care.<br /><br />Implementation occurred in two phases. Phase I began in November 2021, initially covering two of four TJA surgeons and expanding to all surgeons by March 2022. Since then, 555 patients have received enhanced inpatient co-management. Phase II began in April 2023 with the launch of a half-day outpatient clinic staffed by the same hospitalist team; this expanded to a full-day clinic in October 2023. A total of 221 patients have been evaluated in the clinic since its creation.<br /><br />Outcomes were favorable. Average LOS decreased from 1.59 days in the 10 months before Phase I to 1.34 days after Phase I, and further to 1.11 days during Phase II, representing a 30.2% reduction from the start of co-management. Same-day discharges also improved, increasing from 29% to 34.2% during Phase II.<br /><br />Overall, the hospitalist-led model was feasible and associated with improved efficiency and discharge outcomes for TJA patients.

Asset Subtitle

Sandeep Tummala

Meta Tag

Author List Andrew W. Schram, John P. Murray, Sandeep Tummala

Category Innovations

Concept Hospitalist Co-management Model

Concept Arthroplasty

Concept Medical Complexity

Concept Inpatient Co-management

Concept Length of Stay

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Sandeep Tummala

Track Perioperative

Keywords

hospitalist-led co-management

total joint arthroplasty

TJA patients

academic medical center

bundled payments

length of stay

preoperative clinic

perioperative optimization

inpatient co-management

same-day discharge

Hospitalist Co-management Model

Arthroplasty

Medical Complexity

Inpatient Co-management

Length of Stay