Discharge Dilemma: Send Patients Home or to a Rehab to Recover?

Patients who undergo major joint or spine procedures recover just as well at home as they do at acute care facilities, according to a study.

Researchers at NYU Langone Medical Center in New York City compared readmission rates for nearly 5,000 patients who underwent cardiac valve surgery, lower extremity joint replacements or spinal fusions before and after 2012. That was the year the hospital reduced the number of post-op referrals to acute care facilities due to its participation in a Medicare pilot program that tested bundled payments covering hospital stays and 90-day recovery periods.

According to the study's findings, published in JAMA Internal Medicine, 34% fewer patients were discharged to acute care facilities following joint replacement with no significant increase in readmission rates. The same number of spinal fusion patients were discharged to acute care facilities before and after implementation of the program, with no difference in readmission rates between facility-based care and home care.

The study's authors note that Medicare currently spends approximately $59 billion each year on post-op recoveries at acute care facilities. "As clinicians, we often feel that discharging patients to an acute rehabilitation facility may help them recover better and prevent them from returning to the hospital," says study lead author Leora Horwitz, MD, MHS, an associate professor in the Department of Population Health and director of the Center for Healthcare Innovation and Delivery Sciences at NYU Langone.

Dr. Horwitz says the results may give surgeons greater confidence in discharging patients directly home, rather than to another facility, where care is more costly and potentially more disruptive to the lives of patients and families.

Daniel Cook

How Happy Are Your Nurses?

How happy are your nurses? If they're typical, nearly half would choose a different career path, given the opportunity to do so again, and well over half would choose a different practice setting. Those are among the findings of a recent survey of more than 8,000 nurses nationwide. Among the other eye-opening findings: Male nurses are paid significantly higher salaries than female nurses.

Advanced practical nurses (nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists) are most likely to be satisfied with their career choices, with 60% saying they'd do it all again. For RNs, the number is 56% and for LPNs/LVNs the number who say they're satisfied is only 48%. The corresponding numbers who would choose the same practice settings are only 32% (APNs), 22% (RNs) and 12% (LPNs).

Money isn't the biggest issue. Between half and two-thirds of all nurses say they're satisfied with their compensation. And many made as much (39%) or more (52%) in 2014 as they made in 2013. However, only 43% of LPNs think their pay is adequate.

An awareness of persistent gender inequality may lower the level of satisfaction. Average salaries for male nurses are higher across the board: $109,000 vs. $100,000 for APNs; $85,000 vs. $78,000 for RNs; and $49,000 vs. $46,000 for LPNs.

Asked what the most rewarding aspect of the job is, 26% say their relationships with patients, 22% say the fact that they're very good at what they do, 18% say the pride they have in their jobs, 11% say it's good money, and 9% point to the respect they earn from their peers and teams.

Look for Outpatient Surgery Magazine's annual salary survey in our January 2016 issue.

Jim Burger

Is Power Morcellation a Bigger Problem Than We Thought?

The risk of power morcellation performed on women with undetected cancer is higher than research has previously established, according to a new study.

The use of power morcellation during fibroid surgery has been a hot button issue, with the FDA warning last year that the practice may spread undetected cancers. Though some studies have suggested that this possibility is very low, researchers from Boston Medical Center have found that the risk of morcellating cancer is much higher than previously understood.

In their study, they analyzed 19,500 women who underwent laparoscopic hysterectomies or myomectomies to determine how frequently the patients were diagnosed with cancer after undergoing surgery for a problem thought to be benign. Their review of the data found that 1 in 352 women had unsuspected cancer at the time of their gynecologic surgery.

The study also found that more than half of the patients who were diagnosed with uterine cancer or endometrial hyperplasia post-operatively did not undergo endometrial testing prior to surgery. These findings suggest that physicians must improve how they evaluate patients before they undergo procedures with power morcellation, the study's authors write.

"We are continually seeking opportunities to move gynecologic surgery forward," says Rebecca Perkins, MD, the lead author. "Because minimally invasive surgery has many advantages, future research should seek to improve techniques to create safer procedures for women."

Kendal Gapinski

InstaPoll: Are You Pushing for the BSN?

There's an ongoing debate about how nursing education impacts patient outcomes and about the link between professional development and competency. What percentage of RNs at your facility are educated to the level of BSN or higher? Tell us in this week's InstaPoll.

Eighty percent of the 187 respondents to last week's poll have an open position they're trying to fill. Most of those hiring are looking to bring new nurses on board. The results:

Which position are you currently looking to fill?

  • Nursing 46%
  • Surgical tech 24%
  • Reprocessing/housekeeping 6%
  • Business office 4%
  • We don't have any vacancies at the present time 20%

Dan O'Connor

News & Notes
  • Last call for our Stocking Stuffer Contest Would a new FitBit, Apple iPad or Apple Watch be a welcome addition to your holiday season? Then hurry to our Stocking Stuffer Contest before Friday, December 4, to win yours. Simply grab the Product and Services Showcase that arrived with your November issue of Outpatient Surgery Magazine, or click to our digital version, and answer the questions on the contest page. Each correct answer is an entry in our drawing. Good luck, and happy holidays from Outpatient Surgery Magazine.
  • Brush up on infection prevention The "Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care" recently updated for consistency with the CDC's slate of assessment resources, provides a summary reference to the agency's evidence-based recommendations against SSIs.
  • Is infection rate reporting counterproductive? The public posting of hospitals' infection rates mandated by healthcare reform laws was intended to further patient education and quality improvement, but many patients find it difficult to understand the data as presented on CMS's Hospital Compare website, according to a recent study.
  • More effective knee injections? The effectiveness of hyaluronic acid (HA) injections to treat osteoarthritis knee pain may be affected by how much lubricin — a substance that helps anchor HA to tissue and reduces friction — there is in the joint when the HA is injected, say biomedical engineering researchers at Cornell University. They speculate that this finding explains the disparate results of HA's clinical effectiveness trials and opens the door to more effective HA formulations.