Patient satisfaction and clinical outcomes utilizing a patient care coordination team to support same-day discharge following shoulder arthroplasty.

Abstract

A patient care coordination (PaCC) team has been shown to reduce length of hospital stay and direct costs for total hip and knee replacement patients by coordinating successful same-day discharge. There is no prior literature on the impact of a PaCC team on outcomes following shoulder arthroplasty. The aim of this study was to examine factors associated with successful same-day discharge using a PaCC team following shoulder arthroplasty, and the relationship of successful discharge to clinical outcomes and patient satisfaction. This is a single-center retrospective study of all primary total shoulder arthroplasties performed between July 2021 and April 2023 with 1 of 3 fellowship-trained shoulder and elbow surgeons. All patients were part of the PaCC program. Four subgroups were compared based on demographics, clinical outcome, and patient satisfaction: (1) successful planned same-day discharge (SS), (2) failed planned same-day discharge (SX), (3) successful planned next-day discharge (NN), and (4) failed planned next-day discharge (NX). A total of 497 patients and 515 total shoulder arthroplasty cases were included for analysis. There was a higher ratio of female patients in groups anticipated to be discharged next day or failed to be discharged on the same day compared to those successfully discharged on the same day (75.0% SX, 75.4% NN, 69.7% NX vs. 50.9% SS, P < .001). The median body mass index was higher in groups that failed to be discharged on anticipated dates (29.2 [25.8, 33.9] SS vs. 34.6 [29.6, 41.4] SX, 29.6 [24.2, 35.4] NN vs. 32.1 [29.8, 35.9] NX, P = .002). The presence of an active mental health disorder was also higher among patients who failed to be discharged on their anticipated dates (29.6% SS vs. 31.3% SX, 39.3% NN vs. 51.5% NX, P = .042). Reoperation rates were highest in the group of patients that failed next-day discharge (12.1% NX vs. 3.3% NN vs. 3.1% SX vs. 1.5% SS, P = .009). The rate of emergency room visits was also significantly higher in groups that failed planned discharge (3.1% SS vs. 6.3% SX, 1.6% NN vs. 15.2% NX, P = .012). While there was an overall high rate of successful planned same-day discharge using a PaCC program, female-identifying patients, patients with a higher body mass index, and patients with a mental health disorder were at higher risk of failing to discharge as planned. Identifying specific barriers to successful discharge can ensure timely and safe discharge, particularly as practices move toward outpatient shoulder arthroplasty.