• Leonie B Oldmeadow, Helen McBurney, Valma J Robertson, Lara Kimmel, and Barry Elliott.
• Physiotherapy Dept., Alfred Hospital, Melbourne, Australia. L.Oldmeadow@alfred.org.au
• Arch Phys Med Rehabil. 2004 Sep 1;85(9):1424-7.

ObjectiveTo determine whether targeted postoperative care, based on preoperative risk assessment, can increase the number of patients who are discharged home directly from acute care after elective hip or knee arthroplasty.DesignQuasiexperimental with historical control.SettingA public university teaching hospital.ParticipantsOne hundred patients who had an elective hip or knee arthroplasty.InterventionsBetween January and July 2001, 50 patients had their risk of discharge to extended inpatient rehabilitation assessed preoperatively with a newly developed Risk Assessment and Prediction Tool (RAPT). Postoperative management was targeted on the basis of the identified level of risk. Results were compared with those of a similar group of 50 patients treated between January and July 2000.Main Outcome MeasuresDischarge destination, length of stay (LOS), and readmission rates.ResultsThe percentage of patients discharged directly home increased significantly, from 34% during 2000 to 64% in 2001 (P=.002), with no increase in readmission rates in the 12 months postdischarge. In addition, the mean acute hospital LOS decreased by 1.1 days to 7.5 days in 2001 (P=.02).ConclusionsUse of the RAPT and targeted postoperative care resulted in more patients being discharged directly home after hip or knee arthroplasty while hospital LOS further decreased.

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