Reducing variation in total knee replacements.

1 Reducing variation in total knee replacements A new study in the journal Health Affairs of total knee replacement (TKR) confirms that wide variations in care exist among hospitals based on factors such as geographic location. The High Value Healthcare Collaborative found significant variations in TKR among the 5 participating health care systems. Among these were length of stay (LOS), where patients were discharged after surgery, and complication rates (sidebar). The study also reports 3 practices for managing variability: • a multidisciplinary approach to preop preparation, used by the hospital with the lowest in-hospital complication rate • dedicated OR teams for TKRs, used in hospitals with the fastest operating times • managing patient expectations by engaging them in discharge planning even before admission, which started after the data were analyzed, has reduced LOS.