Hein David C, Srivastava Ajay K, Willson Seann E, Telehowski Paul M, Atkinson Patrick J, Atkinson Theresa S
Department of Orthopaedic Surgery, McLaren-Flint, Flint, MI, USA.
Department of Mechanical Engineering, Kettering University, Flint, MI, USA.
Arthroplast Today. 2024 Dec 28;31:101599. doi: 10.1016/j.artd.2024.101599. eCollection 2025 Feb.
Reducing unnecessary emergency department (ED) visits following joint arthroplasty is an important goal. Literature suggests 30-day visit rates range between 4% and 15%, with only 20%-25% of these admitted for care. Low admissions suggest an opportunity to reduce unnecessary postarthroplasty ED visits. This study examined whether a wristband would encourage patients to call the care team with concerns prior to going to the ED.
A wristband displaying a contact phone number was placed on patients at discharge. ED visit rates (30 and 90 days) and readmissions (90 days) were tabulated for 2 years prior to and up to 3 years after the implementation of the wristband program. Residents who responded to calls and call logs were also reviewed.
At 2 years after implementation, a total of 1023 joint replacements produced 273 calls or 1 call per 3.75 patients. Nearly half (48.1%) of the calls were received during weekday work hours when the patients had been directed to call the office. While ED visits declined after the implementation of the wristband at both 2 and 3 years, these reductions were not statistically significant (30 days: 5.1% before, 4.1% after; 90 days: 8.1% before, 7.1% after). There was a significant reduction in 90-day readmissions (6.4% before, 4.0% after).
Patients utilized the wristband number, but this did not significantly reduce the number of ED visits within 3 years. Future studies should track ED visits and identify decision-making factors behind ED use in order to find ways to improve the intervention.
减少关节置换术后不必要的急诊科就诊是一个重要目标。文献表明30天就诊率在4%至15%之间，其中只有20% - 25%的患者因需要护理而入院。低入院率表明有机会减少关节置换术后不必要的急诊科就诊。本研究探讨了腕带是否会鼓励患者在前往急诊科之前就其担忧联系护理团队。
在出院时为患者佩戴显示联系电话号码的腕带。统计实施腕带计划之前2年以及之后3年的急诊科就诊率（30天和90天）和再入院率（90天）。还对回复电话的住院医师和通话记录进行了审查。
实施后2年，共进行了1023例关节置换手术，产生了273次呼叫，即每3.75名患者有1次呼叫。近一半（48.1%）的呼叫是在工作日工作时间接到的，此时患者已被指示致电办公室。虽然在实施腕带后2年和3年时急诊科就诊次数均有所下降，但这些下降在统计学上并不显著（30天：之前为5.1%，之后为4.1%；90天：之前为8.1%，之后为7.1%）。90天再入院率有显著下降（之前为6.4%，之后为4.0%）。
患者使用了腕带号码，但这在3年内并未显著减少急诊科就诊次数。未来的研究应追踪急诊科就诊情况，并确定使用急诊科背后的决策因素，以便找到改进干预措施的方法。
