Managing patient expectations
The first best orthopedic practice was discovered in one of the five hospital systems, which informed patients how long they would be in the hospital, what to expect the day of surgery, and what to expect thereafter until a relative would pick them up to take them home, Tomek says.
"We all think we do this, but as it turned out, one organization spends more time with a multidisciplinary team of nursing staff, physical therapists, and physicians letting these patients know exactly what to expect, and that when they go home, things aren't going to be perfect. They're still going to have pain, and have limits on how they move around,"he says.
This practice limits the typical length of stay, he says, "because patients aren't surprised on day two, for example, that it still hurts them to get out of bed and go to the bathroom." The practice reduces patients' anxiety, which does much to improve outcomes.
He adds that although Dartmouth-Hitchcock offers pre-surgery classes for its knee replacement patients, a visit to them revealed that "they don't stress a timeline as much as they should. ...You need to set clear expectations—for example, these are the points you have to hit before you can go home, and 70% of people hit those by day two."