869 Using six sigma to reduce readmissions in elective total hip & knee arthroplasty

BackgroundNew Hanover Regional Medical Centre is a public, not for profit, teaching hospital that performs over 2000 total joint arthroplasties per year. Following a near 1 million dollar penalty for excess 30 day Hip and Knee readmissions on the FY’15 CMS readmission report, a team was assembled to improve outcomes.ObjectivesThe team’s objective was to identify trends among readmitted patients, conduct root cause analysis to determine process defects, identify risk factors within the population, optimise patients preoperatively, institute a risk scoring system to focus more energy and time with riskier patients, and decrease clinical variation that could lead to complications.MethodsPatient encounter data was used to conduct statistical analysis of medical diagnoses and demographic information to create a preoperative risk tool used to screen patients in preadmission testing. Risky patients were optimised, and received more contact post discharge via phone calls focused on identified risk factors and common readmission reasons.ResultsInitial CMS 3 year aggregate readmission rate was 5.5% versus 4.43% p=0.04 FY18 CMS report and 3.77% p=0.002 FY’19 projected. Risk factor analysis and mirrored intervention strategies by other readmission populations and increased desire and utilisation of orthopaedic preadmission testing optimisation and anaemia clinic by other surgical populations.ConclusionsNew Hanover Regional Medical Centre has statistically reduced readmissions and should receive no further Hip/Knee Arthroplasty Readmission penalties. Six sigma process of patient level analysis, statistically validated risk scoring, patient optimisation, reduced clinical variation, and risk based interventions can be utilised anywhere, with any population, to prevent unwanted outcomes.Abstract 869 Figure 1Hip/knee all payor readmission rateAbstract 869 Figure 2NHRMC total knee/hip risk assessment toolAbstract 869 Figure 33 year CMS hip/knee readmission report