Optimizing Postoperative Care: The Role of a Total Joint Hotline in Reducing Unnecessary Emergency Department Visits.

Abstract

Postoperative concerns after total joint arthroplasty (TJA) frequently lead to emergency department (ED) visits, increasing costs, and affecting outcomes. To reduce unnecessary ED use, our institution implemented a Total Joint Hotline (TJH) to triage patient concerns. The purpose of this study was to determine if the TJH effectively reduced avoidable ED visits. The TJH was launched in March 2021. Patients received a wristband with a phone number, providing direct access to the adult reconstruction care team. They were instructed to call with any postoperative concerns, which were addressed by reassurance, follow-up scheduling, or ED referral as needed. A retrospective review of TJA patients from March 2020 to February 2022 was conducted, dividing patients into pre-TJH and post-TJH implementation groups. A total of 1,410 patients were included, with 642 in the pre-TJH group and 768 in the TJH group. As primary endpoints, ED visits and 30-day readmissions were collected. Statistical analyses included Chi-square, t-tests, and logistic regressions with Firth correction (significance set at P < 0.05). Among those who presented to the ED, models were adjusted for demographics and comorbidities using logistic regressions and validated with inverse probability of treatment weighting (IPTW). Visit rates to the ED decreased from 5.8% pre-TJH to 3.8% post-TJH (odds ratio (OR) 0.64; 95% confidence interval (CI) 0.39 to 1.06; P = 0.08). Overall, 30-day readmission rates were low (0.6 pre versus 1.3% post, P = 0.3). Among ED presenters, readmission was more frequent after TJH implementation (34.5 versus 10.8%; adjusted OR 5.0; 95% CI 1.19 to 20.95; P = 0.03; IPTW OR 4.01; 95% CI 1.16 to 13.92; P = 0.03). Subgroup analyses showed particularly elevated odds of readmission among patients who have obstructive sleep apnea, American Society of Anesthesiologists (ASA) classification III to IV, and men. The implementation of the TJH was associated with a reduction of unnecessary ED visits, as reflected by a clinically meaningful, but not statistically significant, reduction in overall ED utilization, and by the higher likelihood of admission among patients who did present to the ED after its implementation. Although overall readmission rates did not differ, adjusted analyses confirmed that the hotline effectively redirected lower-acuity concerns away from the ED while ensuring that higher-risk patients received appropriate acute care.