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Pre-op initiatives aid discharge planning
Patients attend class, screened before surgery
One patient who was attending a preoperative class for joint replacement patients at Geisinger Health System joked that he was being discharged before he ever got to the hospital, recalls Trisha Whispell, BSN, MSW, ACS, social work care manager, who, with her RN care manager partner, presents a pre-admission class on joint replacement and manages care for patients after surgery.
Patients who are scheduled for elective joint replacement surgery within three or four weeks and their family members attend the classes. The entire team that will be involved with patient care educates those patients on what to expect during and after their hospital stay. The team includes an orthopedic surgeon, a physical therapist, a pharmacist who educates patients on warfarin, and a member of the health system's blood conservation team.
The last 20 minutes of the class focus on transition planning — moving patients through the system from pre-admission until discharge, Whispell says.
She goes over medical equipment needs, insurance matters, care that the family will need to provide after discharge, and the need for transportation from the hospital.
"Discharge planning is a big piece of the program. The patients fill out a questionnaire before the class telling who they live with, how their home is set up, how many steps they will have to climb, how accessible the bathroom is, and other information on what the patient will need to be discharged safely to home," she says.
The team encourages the patients to have a post-discharge plan as well as a backup plan in case there are complications.
For instance, patients may prefer to go home with visiting nurses or outpatient therapy, but their backup plan would be a short stay in a rehab or skilled nursing facility.
The pre-admission classes have increased family involvement as well as patient satisfaction, Whispell says.
Getting the information about discharge needs up front gives the patient and family members an opportunity to start discussing issues and concerns before the surgery occurs, she says.
"We want them to be prepared for anything that might happen. The length of stay for elective joint replacement is usually two to three days. When patients are not screened up front and don't have discharge plans prepared in advance, it can result in a longer length of stay and a lot of stress for the family, which has to make last-minute plans," Whispell explains.
Patients who are having a second joint replacement surgery may omit the program, but they still get a pre-admission screening call.
Patients who can't attend the class receive a video of it. Spanish-speaking patients receive a version that is dubbed in Spanish.
Patients who are insured by Geisinger Health Plan and are having elective joint replacement surgery receive a free physical therapy assessment in their home prior to admission.
"The physical therapists are our eyes in the home. They often pick up on potential problems and send us a note or call us. They begin teaching the patients to use the crutches or walkers to navigate around their home," Whispell says.