Decreasing length of stay after total joint arthroplasty: Effect on referrals to rehabilitation units

Objective: To determine how protocols designed to decrease length of stay on orthopedic services after total joint replacements affect referrals for admission to rehabilitation units. To determine if the physical status scare of the American Society of Anesthesiologists (ASA) is a useful indicator of comorbid illnesses that affect the need for rehabilitation services. Design: Cohort study; consecutive sample. Setting: University medical center. Participants: All patients admitted for total joint arthroplasty between April 12 and October 14, 1997. Main Outcome Measure: Discharge to home or to rehabilitation unit. Results: Length of stay was reduced from 6.4 days in 1995 to 5.1 days in 1997. The percentage of patients admitted to rehabilitation units increased from 18% in 1995 to 33% in 1997. Patients who are older, live alone, and have ASA scores of 3 or 4 were most likely to require admission to a rehabilitation unit. Conclusion: The ASA is a useful measure of comorbidity affecting the need for rehabilitation service. Efforts to decrease cost of acute care services may shift costs of care to postacute services. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.