Addressing Social Drivers Affecting Return to the Emergency Department After Surgery (2024-2025)

Unplanned returns to the emergency department (ED) and readmission rates following orthopaedic surgery are important markers for quality of care. A recent 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. 

Building on the work of the 2023-2024 team, this project team characterized clinical details for return to the ED within 30 to 90 days after orthopaedic surgery, and adjusted clinical practice and discharge counseling in order to help combat any underlying racial disparity.  

Team members studied deidentified medical records and demographic data from adults who underwent orthopedic surgery from 2017-2021 in the Duke University Health System and presented to the ED within 30 to 90 days postoperatively (approximately 400 patients total). Chief complaints in the ED were collected and categorized. After examining demographic data and clinical data, the team worked to understand clinical drivers of disparity in ED return. 

Team members analyzed this data using several different approaches, including statistical tests that were used to understand association of patient level variables with risk of return to the ED; machine learning to generate risk predictions of returns to the ED at the time of discharge; and focus groups with orthopaedic trauma patients, healthcare providers and community groups to identify common factors that contribute to disparities in return to ED that aren’t represented well in clinical data.

While the data collection phase of the project will continue, the team moved forward with designing, implementing and evaluating interventions for improving predischarge counseling or follow-up to help mitigate underlying drivers of disparities in ED return.

Timing

Summer 2024 – Spring 2025

Team Outputs

Manuscripts, posters and presentations

Implementation of a patient AI chat tool for patient questions and concerns

Updated anticipatory guidance for patients discharged from the orthopaedic trauma service

See earlier related team, Addressing Social Drivers Affecting Return to the Emergency Department After Surgery (2023-2024).