title: Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing.
abstract: BACKGROUND
  An early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours.
  
  
  METHODS
  After receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed.
  
  
  RESULTS
  Early evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change (P≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change (P= .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 (P= .038) and had longer hospital stays (P< .001). Early mobilization in the entire cohort was associated with a greater cost savings (P< .001).
  
  
  CONCLUSIONS
  A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.
authors.affiliation: Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Pelt
authors.affiliation: Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA.
authors.forename: Mike B
authors.initials: MB
authors.lastname: Anderson
authors.affiliation: Department of Internal Medicine, The University of Utah, Salt Lake City, UT, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Pendleton
authors.affiliation: Department of Physical Therapy, The University of Utah, Salt Lake City, UT, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Foulks
authors.affiliation: Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
authors.affiliation: Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Gililland
keywords: Early ambulation and value; Physical therapy; Total joint arthroplasty; Value-driven outcomes