Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota.
Mayo Clinic Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota.
J Arthroplasty. 2023 May;38(5):779-784. doi: 10.1016/j.arth.2022.11.002. Epub 2022 Nov 17.
Our institution initiated the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies (OASIS) project in 2017 to improve the quality and efficiency for hip and knee arthroplasties. Phase III of this project aimed to: 1) increase same-day discharge (SDD) of primary total joint arthroplasties (TJAs) to 20%; 2) maintain or improve 30-day readmission rates; and 3) realize cost savings and revenue increases.
All primary TJAs performed between 2021 and 2022 represented our study cohort, with those in 2019 (prepandemic) establishing the baseline cohort. A multidisciplinary team met weekly to track project tactics and metrics through the entire episode of care from preoperative surgical visit through 30 days postoperatively.
The SDD rate increased from 4% at baseline to 37%, with mean lengths of stay (LOS) decreasing from 1.5 to 0.9 days for all primary TJAs. The 30-day readmission rate decreased to 1.2 from 1.3%. Composite changes in surgical volume and cost reductions equaled $5 million.
Application of a multidisciplinary team with health systems engineering tools and methods allowed SDD to increase from 4 to 37% with a mean LOS <1 day, resulting in a $5 million incremental gain in profit at a major academic medical center. Importantly, patient safety was not compromised as 30-day readmission rates remained stable.
III Therapeutic.
我们机构于 2017 年启动了骨科和麻醉学手术改进策略（OASIS）项目，以提高髋关节和膝关节置换术的质量和效率。该项目的第三阶段旨在：1）将初次全关节置换术（TJA）的当日出院率（SDD）提高到 20%；2）维持或降低 30 天再入院率；3）实现成本节约和收入增加。
所有 2021 年至 2022 年期间进行的初次 TJA 均代表了我们的研究队列，其中 2019 年（大流行前）建立了基线队列。一个多学科团队每周开会，通过整个围手术期从术前手术就诊到术后 30 天跟踪项目策略和指标。
SDD 率从基线的 4%增加到 37%，所有初次 TJA 的平均住院时间（LOS）从 1.5 天减少到 0.9 天。30 天再入院率从 1.3%下降到 1.2%。手术量和成本降低的综合变化相当于 500 万美元。
应用多学科团队和健康系统工程工具和方法，使 SDD 从 4%增加到 37%，平均 LOS<1 天，在一家主要学术医疗中心实现了 500 万美元的额外利润增长。重要的是，患者安全没有受到影响，因为 30 天再入院率保持稳定。
III 治疗性。
