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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

Team Leaders

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

Graduate Team Members

  • Solomon Ayehu, MIDP 1 Year Masters
  • Mikhail Bethell, Biomedical Sciences; Medical Student
  • Tristan Chari, Business Administration-MBA; Medical Student
  • Lulla Kiwinda, Medical Student
  • Sally Kuehn, Medical Student
  • Kiera Lunn, Medical Student
  • Aaron Therien, Biomedical Sciences; Medical Student
  • Bruno Valan, Medical Student; Master of Egr AI for Product Innovation

Undergraduate Team Members

  • Shloka Bhakta, Biology (BS)
  • Alex Brady, Spanish (AB)
  • Olivia Scott, Biology (BS); Spanish (AB2)
  • Camila Suarez, Psychology (BS)
  • Daniel Zeng, Computer Science (AB)

Community Organizations

  • Duke University Health System

Team Contributors

  • William Bleser, Margolis Center for Health Policy
  • Andrew George, Duke University Hospital
  • Andrew Olson, School of Medicine: Duke Clinical Research Institute
  • Steve Olson, School of Medicine: Orthopaedic Surgery
  • 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
  • Erica Taylor, School of Medicine: Orthopaedic Surgery
  • Alison Toth, School of Medicine: Orthopaedic Surgery