The development and testing of the Predictor of Appropriate Discharge Destination among patients undergoing elective total knee or hip joint arthroplasty

Abstract

Objective: The aim of this study was to develop and test a tool, the Predictor of Appropriate Discharge Destination (PADD), used postoperative day zero by healthcare professionals to identify whether patients undergoing elective total knee arthroplasty or total hip arthroplasty should go directly home or to extended rehabilitation. A secondary objective was to examine the difference in readmissions pre and post use of the PADD. Design: A two-phase methodological study. Setting: This study was conducted in a 393-bed magnet re-designated community hospital. Subjects: Adults undergoing a primary total knee or hip arthroplasty. Methods: In Phase 1, retrospective data (n = 461) was analyzed to compare recommendations for discharge destination between the PADD and physical therapists. In Phase 2 (n = 521), the predictive validity of the PADD was assessed prospectively. Results: In Phase 1, the PADD cut-off score of ⩽7 demonstrated good sensitivity (0.83) and specificity (0.68) in relation to the physical therapist’s discharge destination recommendation. In Phase 2, sensitivity (0.75) and specificity (0.83) calculations were similar. Analysis of 30-day readmissions between the physical therapist’s recommendation and the PADD score revealed 89.7% agreement. Readmission percentages among patients discharged to home and to rehabilitation facilities were 2.37% (n = 16) and 3.41% (n = 10), respectively. Conclusion: The PADD has good predictive validity in relation to appropriate discharge destination for patients undergoing a total knee or hip arthroplasty.