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At the Hospital for Special Surgery, approximately 3000 joint arthroplasties of the hip and knee are performed yearly. Cost reduction and improved efficiency in total joint replacement without compromise in quality of care has been a severe challenge in this environment of reduced reimbursement.
COST-SAVING MEASURES
To effect cost savings, increase availability of inpatient bed capacity for volume growth, and bring the patient to a functionally independent state more rapidly, a number of measures have been adopted. These include preoperative patient education classes, incorporation of standardization of care by consensus of the arthroplasty surgeons, and reduction of hospital stay and implant costs.
PREOPERATIVE CLASSES
The development of preoperative classes for joint replacement patients was a collaboration of surgeons, physical therapists, social workers, and nurses. A manual and videotape have been developed and are given to the patients when they arrive at the class. The manual describes the process of hip and knee replacement and recovery in a sequential fashion from preadmission to full recovery.
The classes are taught by a clinical nurse practitioner and a physical therapist. A social worker is usually present to review plans for postoperative recovery. Currently, about 90% of all arthroplasty patients attend the class, which is coordinated on the day patients undergo preadmission testing, medical consultation, and autologous blood donation.
In comparing length of stay for patients who have taken the class with those who...