Modifying the RAPT Score to Reflect Discharge Destination in Current Practice

Area of Science:

• Orthopedic Surgery
• Health Services Research

Background:

• The Risk Assessment Prediction Tool (RAPT) is a validated survey for predicting discharge disposition in primary total joint arthroplasty (TJA) patients.
• Current RAPT scoring may be outdated due to advancements in rapid-discharge protocols and increased home care utilization.

Purpose of the Study:

• To evaluate the effectiveness of modified scoring cutoffs for the RAPT (mRAPT) in predicting discharge disposition for TJA patients.
• To assess if mRAPT improves predictive accuracy in the context of modern discharge trends.

Main Methods:

• A retrospective chart review of 1264 primary TJA patients was conducted over 14 months.
• The RAPT score was implemented mid-study, allowing for pre- and post-implementation outcome analysis.
• Exclusion criteria included revision TJA, complex TJA, and TJA after malignancy resection.

Main Results:

• The post-RAPT implementation group showed a significant decrease in mean hospital length of stay (2.22 to 1.82 days) and a reduction in facility discharges (21.8% to 15.2%).
• The modified RAPT system achieved 92% overall predictive accuracy and accurately predicted hospital length of stay.
• Significant improvements were observed in both total hip arthroplasty and total knee arthroplasty subgroups.

Conclusions:

• Published RAPT scoring cutoffs are inaccurate for current TJA discharge practices, which increasingly favor home services.
• Implementing modified RAPT (mRAPT) cutoffs maximizes predictive capabilities for patient discharge disposition.
• The mRAPT system maintains excellent predictive accuracy while better aligning with contemporary healthcare trends.