Just 6 Questions Can Determine Discharge Status

A new 11,600 patient study from the Cleveland Clinic Foundation put to the test two discharge planning tools—one preop and one postop. According to the resulting paper, “PLAN and AM-PAC “6-Clicks” Scores to Predict Discharge Disposition After Primary Total Hip and Knee Arthroplasty,” which appears in the February 16, 2022, edition of The Journal of Bone and Joint Surgery, just six questions can predict discharge status.

The researchers used the preoperative tool, Predicting Location after Arthroplasty Nomogram, along with the postoperative Activity Measure for Post-Acute Care “6-Clicks.” Variables in the Predicting Location after Arthroplasty Nomogram include comorbidities, home characteristics, caregiver assistance, and preoperative ambulatory status.

According to co-author Nicolas S. Piuzzi, M.D., “The Activity Measure for Post-Acute Care (AM-PAC™) ‘6-Clicks’ Inpatient Short Forms are multidimensional measures that use six questions to assess functional outcomes of patients in post-acute care settings. The 6-Clicks questions assessed were: rolling in bed, sitting up, transferring to chair, standing up, walking, and climbing stairs.”

“As we continue to work on increasing value to patients in total joint arthroplasty [TJA] care, evidence-based orthopaedic surgery is of paramount importance,” stated Dr. Piuzzi to OTW. “One of the relevant aspects of the episode of care during TJA is the determination of post-discharge needs after THA [total hip arthropolasty] and TKA [total knee arthroplasty] which remains a complex clinical decision.”

Of the 11,672 patients in the study, 4,923 underwent THA and 6,749 underwent TKA from December 2016 through March 2020.

“PLAN and ‘6-Clicks’ basic mobility scores were good-to-excellent predictors of discharge disposition after primary total joint arthroplasty, suggesting that both preoperative and postoperative variables influence discharge disposition,” said Dr. Piuzzi to OTW. “We recommend that preoperative variables be collected and used to generate a tentative plan for discharge, and the final decision on discharge disposition be augmented by early postoperative evaluation.”

“This study shows how simultaneously exploring the predictive ability of preoperative and postoperative assessment tools on discharge disposition after total joint arthroplasty may be a useful aid in a value-driven health-care model.”

“At the Cleveland Clinic,” stated Dr. Piuzzi to OTW, “we currently use both tools in the care of TJA patients to better plan and assist in discharge disposition planning. Additionally, these tools are used in combination with several other tools to predict relevant metrics that influence patient safety and outcomes (e.g., length of stay, readmission, complications, etc.) in our continued attempt to practice evidence-based orthopaedic surgery.”