Immediate Interventions After Surgery to Reduce Readmission for Upper Extremity Infections

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Rehabilitation Medicine

Background:

• Upper extremity infections (UEIs) often stem from intravenous drug use or trauma, leading to severe outcomes.
• Patients with UEIs frequently experience high rates of emergency department (ED) revisits, repeat surgeries, functional deficits, and increased healthcare costs.
• Postoperative hand therapy is recognized as crucial for improving outcomes in patients with UEIs.

Purpose of the Study:

• To investigate and intervene in the care pathway for patients undergoing surgery for upper extremity infections (UEIs).
• To evaluate the impact of a structured intervention, including education and hand therapy referral, on patient outcomes and healthcare utilization.
• To reduce emergency department burden and healthcare expenditure associated with UEI treatment.

Main Methods:

• A 2-phase study was conducted at a single urban university hospital involving patients with UEIs requiring surgery.
• Phase 1 (control): Standard care including discharge instructions, follow-up scheduling, and hand therapy evaluation.
• Phase 2 (intervention): Standard care plus a scripted educational session on hand therapy importance, home exercise program, and pre-discharge hand therapy referral.

Main Results:

• The intervention group showed a significant increase in follow-up appointment attendance (54% vs. 43%, P = 0.044) and hand therapy utilization (22% vs. 2%, P = 0.013).
• Emergency department visits for the same complaint decreased significantly in the intervention group (24% vs. 45%, P = 0.047), with 40 ED visits compared to 167 in the control group.
• While reoperation rates did not change significantly (P = 0.1), the intervention group experienced fewer readmissions (7 vs. 11).

Conclusions:

• An early, simple intervention involving education and hand therapy referral is effective in reducing emergency department burden and healthcare expenditure for UEI patients.
• This intervention improves patient follow-up rates and decreases readmissions and ED revisits.
• The enhanced care pathway demonstrates a cost-effective strategy for managing challenging UEI patient populations.