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Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies (OASIS) Project – Phase III Outcomes

Published:November 17, 2022DOI:https://doi.org/10.1016/j.arth.2022.11.002

      Abstract

      Introduction

      Our institution initiated the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies project in 2017 to improve 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.

      Patients and Methods

      All primary TJAs performed between 2021 and 2022 represented our study cohort, with those in 2019 (pre-pandemic) 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 postoperative.

      Results

      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 versus 1.3%. Composite changes in surgical volume and cost reductions equaled $5 million.

      Conclusion

      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.

      Key Words

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