title: Preadmission screening of patients scheduled for hip and knee replacement: impact on length of stay.
abstract: OBJECTIVE
  An evaluation of the impact of a social work preadmission program on length of stay (LOS) of orthopedic patients undergoing elective total hip or total knee replacement surgeries (under diagnosis-related groups [DRGs]) at the Hadassah Ein-Kerem Hospital in Jerusalem is Israel.
  
  
  METHODS
  The social work interventions included preadmission psychosocial evaluation and preliminary discharge planning, coordination of nursing and physiotherapy evaluations, ensuring completion of all medical tests prior to admission, and additional psychosocial follow-up during hospitalization to carry out the original discharge plan or prepare alternatives.
  
  
  METHODS
  The intervention patients were divided into two groups in order to see changes over time: May through December 1994 (n = 48), and January through December 1995 (n = 81). The comparison groups included patients operated on at the same hospital during 1993 (n = 51) and during January through April 1994 (n = 21) and at the Hadassah Mount Scopus Hospital during the same time periods. Patients in the comparison groups received usual social work intervention, as necessary, only after hospitalization.
  
  
  RESULTS
  Mean LOS was reduced significantly in the intervention patient groups, as compared to the preintervention patient groups in the same hospital, from 14.2 days (standard deviation [SD], 4.7) in 1993 and 14.7 (SD, 5.1) in January through April 1994 to 10.9 (SD, 3.0) in May through December 1994 and to 9.1 (SD, 2.8) in 1995 (P < .01). Length of stay also was reduced in the comparison hospital, but by 1995 was longer than in the intervention patients. No differences in LOS by gender, age, or marital status were found. Length of stay was significantly longer for those undergoing total hip replacement as compared to those undergoing total knee replacement in all the groups.
  
  
  CONCLUSIONS
  Preadmission screening and case management by a social worker can contribute to the efforts to decrease LOS of orthopedic patients by early multidisciplinary evaluations, discharge planning, and coordination of services.
authors.affiliation: Department of Orthopedics, Hadassah University Hospitals, Jerusalem, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Liebergall
authors.forename: V
authors.initials: V
authors.lastname: Soskolne
authors.forename: Y
authors.initials: Y
authors.lastname: Mattan
authors.forename: N
authors.initials: N
authors.lastname: Feder
authors.forename: D
authors.initials: D
authors.lastname: Segal
authors.forename: S
authors.initials: S
authors.lastname: Spira
authors.forename: G
authors.initials: G
authors.lastname: Schneidman
authors.forename: Z
authors.initials: Z
authors.lastname: Stern
authors.forename: A
authors.initials: A
authors.lastname: Israeli
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003955:Diagnostic Tests, Routine; D005069:Evaluation Studies as Topic; D005260:Female; D006302:Health Services Research; D006801:Humans; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D011787:Quality of Health Care; D012948:Social Work Department, Hospital / Q000458:organization & administration*