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869 Using six sigma to reduce readmissions in elective total hip & knee arthroplasty
  1. Brandon Hill1,
  2. Eva Pittman1,
  3. Hannah Lanier1,
  4. Karen Hines1,
  5. Charmaine Lewis1,
  6. Jack Bowling2,
  7. Caitlin Dunn1,
  8. RoseAnn Gosswein1,
  9. Shirley Glockner1,
  10. David Oehler1,
  11. Pam Cumber1,
  12. Alice Matthews1
  1. 1New Hanover Regional Medical Centre, US
  2. 2Bowling Orthopaedics, US


Background New 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.

Objectives The 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.

Methods Patient 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.

Results Initial 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.

Conclusions New 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 1

Hip/knee all payor readmission rate

Abstract 869 Figure 2

NHRMC total knee/hip risk assessment tool

Abstract 869 Figure 3

3 year CMS hip/knee readmission report

Statistics from

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