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US, UK Physicians Team Up to Improve Ortho Quality

Ben Cole, for HealthLeaders Media, May 19, 2009

Editor's Note: This is the first in a two-part series about the partnership between Glen Cove Hospital and the National Health Service Elect.

British healthcare leaders recently visited a prominent U.S. hospital to share orthopedic best practices and workforce development—a partnership that both sides say could ultimately benefit their national health systems.

Sponsored by the National Health Service Elect and the British Department of Health, orthopedic surgeons and anesthesiologists from the United Kingdom observed hip and knee replacement surgeries performed by Eugene Krauss, MD. Krauss is chairman of orthopedics at Glen Cove (NY) Hospital, part of the North Shore-LIJ Health System.

Krauss and his team at Glen Cove perform more than 1,100 joint replacements annually with an infection rate of virtually zero. It is touted as one of the premier joint replacement models in the U.S.

"For them to be interested in a cooperative program with myself and my program at Glen Cove Hospital-North Shore was a wonderful opportunity and honor for us," Krauss says. "The goal was 'can we reproduce our efficiency models and can we help them?'"

According to Peter Kay, MD, president-elect of the British Orthopedic Association and one of the UK's representatives in the partnership, the lessons learned from examples at Glen Cove will help as the UK tries to achieve the NHS goal of having wait times for elective surgery reduced to no more than 18 weeks.

Kay notes that as recently as a few years ago, U.K. patients would have to wait two or three years for a joint replacement.

"What we call the patient pathway was getting a bit long and a bit complicated, so the big push has been to rationalize all of that to make it must simpler, and much quicker to get patients through the system," says Kay, who is also a practicing orthopedic surgeon at Wrightington Hospital in the UK. "And obviously in order to do that, we've had to modernize and change what we do."

In addition to observing during the surgeries, healthcare leaders from both sides of the pond discussed surgical methods, efficiency models, and tactics used by the surgical team. The 30 people who visited Glen Cove included representatives from the National Health Service and West Suffolk NHS Trust Hospital.

The program's agenda also included site visits to North Shore-LIJ's Center for Learning and Innovation and its Patient Safety Institute in Lake Success, NY, as well as the health system's Bioskills Education Center, a state-of-the art surgical training center. Discussions took place about workforce development and the role of nurses, nurse practitioners, and physician assistants in delivering orthopedic care to patients in the continuum of care.

"Much of what I've done in our field is related to that continuum of care," says Krauss. "You break down the process to multiple, small quality assurance steps. There is a whole team involved."

This team-oriented process is very important, which he says he tried to get across to the team from the UK. He says Glen Cove has joint replacement teams that have been working together since 1993, allowing for a seamless process from consultation to follow-up care that is best for the patient, as well as the staff.

This team effort allows for Glen Cove to conduct 12-14 joint replacements in a single day—with superior outcomes.

"It's like dancing a ballet with all the same partners—it's not like a pickup team," Krauss says. "People have this idea that if you do a lot of these they must be not as good quality—but the opposite is true. When you do a lot, you have a center of excellence and they are better."

Kay says he is impressed that patients really felt like they were being looked after by a good team, and the staff seemed to be really enjoying their jobs.

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