Knee-Replacement Needs

Joe Cantlupe, for HealthLeaders Media , July 13, 2011
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“In developing this center, we standardized and optimized patient care preoperatively,” says Michael B. Vessely, MD, medical director and orthopedic surgeon for Willamette Valley Medical Center and head of the hospital’s joint-replacement institute. Emphasizing care preoperatively helps ensure proper patient flow, he says. “We incorporate the records from the patient’s own primary care physician,” Vessely says, “and then we set up our hospitalists to see the patients and treat them for any medical problems, such as establishing a smoking cessation program if they smoke, or if they have sleep apnea, get them referred to a sleep program.”

Standardization is a key element in the multidisciplinary approach for patient care, whether it’s how much icing patients need or when they can take showers, he says.

“The nurses and other specialists in the unit, they all know what to do—they tell the patients the same thing,” Vessely says. “Even if it is something as simple as ‘How do I ice my knee?’ if three different people are telling them three different things, they may think we don’t know what we are talking about, so that doesn’t happen. We are all on the same page. Icing may seem like a simple thing, but communicating is important for patient perception.”

A standardized program is important for improved outcomes and coordinated care that gets the patient prepared to “move” following surgery, says Vessely.

“When patients have gotten up in the morning, and they see that all their beds are made, the subtle message is they aren’t going back to bed,” Vessely says. “At the hospital, [the patients] get a little newsletter each day to tell them what is expected for that day, working with the occupational therapist and others in the unit. In our unit, there are six beds, and it’s only for people who have hip or knee replacement.”

The multidisciplinary approach has been successful in improving outcomes, says Natalie Reed, joint coordinator for the hospital. According to the hospital reports, within three months after surgery, there have been improvements. Before the program began more than a year ago, five of eight people surveyed felt mild or no pain while walking—62.5%, which is below the national average of 82%. After the program was initiated, five of five people surveyed felt mild or no pain. Previously, patients had more difficulty with stairs, she says, noting that four of eight patients surveyed had mild to no pain with stairs, compared to recent figures of five of five surveyed with mild to no pain. The national average is 79%, she says. Although the numbers were relatively small in the survey sampled, they reflect improvements in outcomes, according to Reed.

Generally, Hoffman of Stamford Hospital says, it is important for a service line to develop a coordinated program to overcome lack of understanding within staff. An organizational framework includes the executive committee to develop strategic plans and consistently review progress in the service line, which ensures commitment to the program, she says. A separate service line committee for orthopedics “takes ownership” for achieving goals and develops crucial relationships with the physicians to carry the program forward, she says.

Success Key 2: Patient involvement

When St. Mary’s Regional Medical Center in Maine sought to improve its patient satisfaction scores, it went to the source: It asked patients for their advice to improve the healthcare system.

For years, the hospital did not have the patient satisfaction scores it sought, and was below the 90% that hospital leaders thought was acceptable. So it decided to turn around the program, enlisting patient advisors in a makeover of the program, according to Farinas. As many as 30 patient advisors were involved in transforming the program in areas ranging from location of beds to pain control, he says.

Initially, patients responded to surveys and told hospital leaders they weren’t as satisfied as officials hoped in mastering the hospital system in ways such as scheduling and finding answers to their questions, Farinas says. Overall, “it was not quite as smooth as I had hoped,” he says. Patients who were questioned a year after surgery “told us they had not experienced the hospitalization or recovery that they wanted to have,” he says.

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