Optimizing Postoperative Care: The Role of a Total Joint Hotline in Reducing Unnecessary Emergency Department Visits

Postoperative concerns after total joint arthroplasty (TJA) frequently lead to emergency department (ED) visits. To reduce unnecessary ED use, our institution implemented a Total Joint Hotline (TJH) to triage patient concerns. The purpose of this study was to determine if the TJH effectively reduced avoidable ED visits.

The TJH was launched in March 2021. Patients received a wristband with a phone number, providing direct access to the adult reconstruction care team. They were instructed to call with any postoperative concerns, which were addressed by reassurance, follow-up scheduling, or ED referral as needed. We retrospectively reviewed 1,410 TJA patients between March 2020 and February 2022 (642 pre-TJH; 768 post-TJH). Primary endpoints included ED visits and 30-day readmissions. Statistical analyses included Chi-square, t-tests, and logistic regressions with Firth correction (significance set at P < 0.05).

Visit rates to the ED decreased from 5.8% pre-TJH to 3.8% post-TJH (odds ratio (OR) 0.64; 95% confidence interval (CI) 0.39 to 1.06; P = 0.08). Overall, 30-day readmission rates were low (0.6% pre-TJH versus 1.3% post-TJH, P = 0.3). Among ED presenters, readmission was more frequent after TJH implementation (34.5 versus 10.8%; adjusted OR 5.0; 95% CI 1.19 to 20.95; P = 0.03).

The implementation of the TJH was associated with a reduction of unnecessary ED visits, as reflected by a clinically meaningful, but not statistically significant, reduction in overall ED utilization, and by the higher likelihood of admission among patients who did present to the ED after its implementation. Although overall readmission rates did not differ, adjusted analyses confirmed that the hotline effectively redirected low-acuity concerns away from the ED while ensuring that high-risk patients received appropriate acute care.