Surprising New Reason for Hospital Readmission Rates

Where a patient lives may be one of the most powerful reasons they return to the emergency room (ER) and are readmitted following total joint surgery.

According to a new study from the Hospital for Special Surgery (HSS) in New York City and the Ochsner Clinic in New Orleans, patients who live close to the hospital are much more likely to visit the emergency room for follow-up care of pain, inflammation and other issues than those who live farther away.

Those who live far from the hospital are much more likely to call their surgeon with questions.

“Intuition would say that they came to the ER because it’s available,” said Bradford S. Waddell, M.D., a hip and knee surgeon at HSS, who led the study. “Everybody is hurting after knee and hip surgery, but if you have easy access to the ER you’re just going to pop on in.”

Dr. Waddell explained the genesis of the study to OTW, “We noticed a trend that patients were being discharged sooner and with the introduction of the electronic medical records, we felt that there was an increase in communications to the physician, either by phone or by email. This led us to investigate who was calling versus showing up to the clinic. With that, we expanded to see if those who traveled further had more complications as a result of being further from the ER.”

The authors collected data from 4,003 surgeries and then organized that data according to how far patients lived from the hospital where they had their joint surgery. Patients who lived close to their hospitals had 7% more clinic visits than patients who live far from their hospital. Digging deeper, the researchers found that patients who lived close to their hospital and patients who lived a medium distance from their hospital had 36% and 28% more emergency department presentations than patients who lived far from their hospital. Finally, the researchers noted that the close by and medium distance patients had 62% and 24% more hospital readmissions than the ‘far’ distance group, respectively.

Dr. Waddell summarized the results to OTW, “When we looked at the data, we were surprised to see that patients who lived closer to the hospital/ER, presented to the ER more often for reasons not requiring readmission (such as pain and swelling). This has led us to change how we educate patients, so they call us or show up in the clinic, as opposed to the very expensive ER.”

Asked about particular language that might be helpful in counseling patients, Dr. Waddell told OTW, “Basically, explaining that while one day you will be extremely happy you had a joint replacement, the healing process can be quite rigorous and painful. We have opened lines of communication so that the patients are more likely to call us before appearing to the ER.”