BACKGROUND: The Risk Assessment and Prediction Tool (RAPT) is used to predict 
patient discharge disposition after total joint arthroplasty. Following a 
comprehensive, multidisciplinary redesign, our institution noticed a trend 
toward home discharge in patients with RAPT scores that historically predicted 
discharge to acute care facilities, presenting an opportunity to redefine the 
predictive ranges for RAPT.
METHODS: Retrospectively collected data were analyzed from a single institution 
in patients undergoing elective primary total joint arthroplasty from January 
2016 to April 2017. Predictive accuracy (PA) was calculated for each RAPT score 
(1-12), RAPT score risk ranges (low, intermediate, and high), as well as 
overall. Other factors evaluated included patient-reported discharge 
expectation, body mass index, and American Society of Anesthesiologists scores 
as related to discharge disposition and the PA of RAPT.
RESULTS: Overall PA of RAPT was 88% (n = 1024 patients). Patients were high risk 
for acute care facility with a RAPT score of 1 to 3 (PA ≥ 83%), intermediate 
risk 4 to 7 (PA, 52%-79%), and low risk 8 to 12 (PA ≥ 89%). In multivariable 
analysis, RAPT score and patient-reported discharge expectation had the 
strongest correlation with actual discharge disposition.
CONCLUSION: Our multidisciplinary redesign has impacted the PA of RAPT. The 
original predictive ranges should be modified to reflect the increasing 
proportion of patients being discharged home following elective arthroplasty 
procedures. We have identified patient-expected discharge destination as a 
powerful modulator of the RAPT score and suggest that it be taken into 
consideration for discharge planning.