Racial Disparities in Emergency Department Return After Orthopaedic Surgery (2023-2024)

Unplanned returns to the emergency department (ED) and readmission rates following orthopaedic surgery are important markers for quality of care. A quality improvement project at Duke Health revealed that Black patients were more likely to present to the ED after orthopaedic surgery without a difference in readmission rates compared to white patients. 

This project team analyzed the factors associated with emergency department return after orthopaedic trauma surgery, expanding the patient cohort from the pilot study and finding that both race and public insurance status are independent predictors of return to the ED.

The team held focus groups with orthopaedic trauma patients to better understand the issues that they faced upon discharge from the hospital with the goal of improving the discharge counseling process.

Finally, team members began a pilot study exploring the use of a large language model-based check-in system that will automatically follow up with patients at predetermined intervals after surgery. The goal of this effort is to provide patients with continuous support and attention after discharge from the hospital and prevent unnecessary ED visits.

In 2024-2025, the team will quantify the impact of the interventions and publish their findings.

Timing

Summer 2023 – Spring 2024

Team Outputs

Improved guidance for patients discharged from orthopaedic surgery

Focus groups with orthopaedic trauma patients

Intervention implementation

Conference presentations

Racial Disparities in Emergency Department Return After Orthopaedic Surgery (Poster presented at Fortin Foundation Bass Connections Showcase, April 17, 2024)

Race and Government-Funded Insurance are Independent Predictors of Return to the Emergency Department after Orthopaedic Trauma Surgery Within the Global Period (Abstract accepted for Orthopaedic Trauma Association 2024 Annual Meeting, Montreal, Canada, October 2024)

See related team, Racial Disparities in Emergency Department Return After Orthopaedic Surgery (2024-2025).

 

Image: Foot and Ankle Orthopaedic Surgeon Andrew Hanselman, MD, examines a patient’s achilles during an appointment at Duke Orthopaedics Heritage, by Erin Hull/Duke Health

Male doctor examining ankle and foot of a female patient.

Team Leaders

  • Malcolm DeBaun, School of Medicine-Orthopaedic Surgery
  • Kiera Lunn, School of Medicine–Med Student
  • Emily Peairs, School of Medicine–Med Student
  • Jay Swayambunathan, School of Medicine–Med Student

/graduate Team Members

  • Mikhail Bethell, Medicine MD Third Year
  • Solomon Ayehu, MIDP 1 Year Masters
  • Bruno Valan, Master of Engineering, Artificial Intelligence, Medicine MD Third Year
  • Aaron Therien, Biomedical Sciences
  • Tristan Chari, Grad Innovation & Entrprship
  • Lulla Kiwinda, Medicine MD Third Year
  • Sarah Kuehn, Medicine MD Second Year

/undergraduate Team Members

  • Daniel Zeng
  • Camila Suarez
  • Olivia Scott
  • Alexander Brady
  • Shloka Bhakta

/yfaculty/staff Team Members

  • Andrew Olson, School of Medicine-Duke Clinical Research Institute
  • Alexandra Paul, School of Medicine-Orthopaedics
  • Christian Pean, School of Medicine-Orthopaedic Surgery
  • Sherri Pearce, Duke University Health System
  • John Purakal, School of Medicine-Surgery: Emergency Medicine
  • Andrew George, Duke University Hospital
  • Erica Taylor, School of Medicine-Orthopaedic Surgery
  • Alison Toth, School of Medicine-Orthopaedic Surgery
  • William Bleser, Margolis Center for Health Policy

/zcommunity Team Members

  • Duke University Health System