Same-Day Discharge Protocol for Total Joint Replacement
(PTClearSHoT Trial)
Trial Summary
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the same-day discharge protocol for total joint replacement treatment?
Is same-day discharge after total joint replacement generally safe?
What makes the same-day discharge protocol for total joint replacement unique?
The same-day discharge protocol for total joint replacement is unique because it allows patients to go home on the same day as their surgery, thanks to advances in anesthesia, physical therapy, and surgical techniques. This approach is designed to be safe and cost-effective for selected patients, although it may have higher complication rates compared to fast-track inpatient procedures.23479
What is the purpose of this trial?
Conventionally, physical therapy (PT) clearance is sought before total joint arthroplasty (TJA) discharge. However, PT staffing limitations may preclude same-day discharge in patients having surgery late in the day. Failed same-day discharge in eligible TJA patients results in unnecessary hospital bed occupancy, which increases costs, limits operating room throughput for patients requiring inpatient admission, and introduces risks associated with longer length-of-stay.In collaboration with an institutional PT department, the investigators developed a protocol for discharging same-day TJA patients without postoperative PT clearance. Immediately preoperatively, PT administers gait training. Patients are then discharged home after ambulating with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization. This allows for the maximum number of patients discharged home, including the last patient of the day, PT staffing limitations notwithstanding. Single-institution pilot data demonstrates no increased risk of falls, emergency room (ER) visits, or readmissions with this process.The investigators propose a prospective, controlled, multicenter study to expand on pilot data. The study aim is to assess safety of day-of-surgery preoperative PT and postoperative ambulation with PACU nursing before TJA discharge. The primary endpoint is postoperative falls, while secondary endpoints include 90-day ER visits, 90-day hospital readmissions, patient-reported outcome measures, and patient satisfaction scores.
Eligibility Criteria
This trial is for adults over 18 who are having a total hip or knee replacement and can go home the same day. They need someone to stay with them at home for a week after surgery and must be medically okay to leave the hospital after waking up from anesthesia.Inclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Preoperative Physical Therapy
Participants receive gait and stair training from physical therapy prior to total joint arthroplasty
Postoperative Ambulation
Participants ambulate with post-anesthesia care unit (PACU) nurses trained by PT on postoperative mobilization before home discharge
Follow-up
Participants are monitored for safety and effectiveness after treatment, including assessment of postoperative falls, ER visits, and readmissions
Treatment Details
Interventions
- Conventional postoperative physical therapy clearance
- Novel same-day discharge protocol after total joint arthroplasty
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Maryland, Baltimore
Lead Sponsor
Rothman Institute Orthopaedics
Collaborator