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Knee-Replacement Needs

Joe Cantlupe, for HealthLeaders Media, July 13, 2011
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Essentially, hospital officials determined that it was simply a matter of patients having difficulty “getting through the system,” he says. “It became crucial for us to absolutely focus on the patient experience.”

“The patients were enlisted as advisors to help transform the experience,” he says. “It became a priority for our patient advisors to enlighten us to the fact that we had to redesign our program accordingly. It was a tough pill to swallow. But it gave us a roadmap,” he says.”

“There had been uncertainty with the patients about what was coming next and where to move from one transition area to the next,” he adds. “Not knowing what was ahead in the next hour or the next 15 minutes, they had difficulty coming in and out of our system. They had difficulty understanding where certain locations were, or understanding navigating the system.”

With the help of patient advisors, the hospital has gradually transformed its system, architecturally as well as clinically, Farinas says. The hospital also redesigned its rooms. Among other things, it installed an in-unit rehab gym designed to simulate a home environment, a nutrition and snack station for families, and an education room with Internet access for patients and families.

Through a multidisciplinary approach and varied committee meetings, the hospital staff also worked to improve patient outcomes, step by step.

Prior to the opening of the Center for Joint Replacement, patients often stated that pain was limiting the speed of their recovery. The staff made the decision to transition from the use of epidurals to intraoperative injections and preemptive oral pain medication administration. “The outcome to this change caught us off guard,” Farinas said. “Whereas we traditionally struggled to mobilize patients on postop day 1, patients were now able to stand and walk to the bathroom as soon as two to three hours after surgery.”

Success Key 3: Nurse navigator

Having educational programs and a patient coach, such as a family member who works with a hospital team led by a nurse navigator or joint-care coordinator, have become critical elements for many hospitals trying to improve conditions in knee and orthopedic care.

Hospitals also are improving their rehabilitation programs by engaging patients in social interaction and even mild competition with other patients while improving patient satisfaction and reducing length of stay.

At the Willamette Valley Medical Center, patients are introduced to others who experienced similar knee surgeries. For additional support, patients are asked to identify a coach to help them in the hospital or after an operation, Reed says. The coach and patient participate in group therapy classes that focus on home exercise and the recovery program. “The question of who is going to be the coach starts in the physician’s office,” says Reed. “We all want to be on the same page and give the patient as much information as we can,” she says.

With a coach in place, hospitals also are adding camaraderie and teamwork to the mix to assist patient recovery. At the 208-staffed-bed Metro Health Hospital, in Wyoming, MI, hospital officials launched a joint-replacement camp to help patients improve their rehabilitation in a group setting, and patients are encouraged to measure their progress against fellow campers. The camp is seen as a structured way to assist patients, also with the aid of a coach.

“Our patients participate in two daily group physical therapy sessions,” says Mary Brady, Metro Health Hospital’s program coordinator for the Center for Restorative Care. “The group therapy session is unique. Jokingly, I say ‘misery does love company’ but the camaraderie between patients and coaches works very well.”

Over the past seven years, the joint-replacement camp has helped reduce the length of stay from nearly four days to three days, Brady says. “The greatest physician selling points on this project came from the patients themselves,” she says, noting that patient satisfaction scores were around 99%, among the highest in the hospital. “Patients also voiced a high degree of confidence with going home and being able to take care of themselves after discharge from the hospital,” she says. The patient satisfaction survey interviewed 199 patients from July 2010 to March 2011.

There have been cost savings, too, she says. “Supply costs were examined and some simple reductions were made,” Brady says. “Vendors were asked to work on pricing negotiations within the surgery department to minimize prosthetic expenses and inventories. We also educated the orthopedic doctors on the wide range of hospital costs for them to support and understand the overall process. As long as the costs could be minimized without compromising quality and allowing for individuality, the physicians were in agreement.”

Deborah Valentine, RN, the clinical care coordinator for Stamford Hospital, sees herself as the “liaison for the patient, physician, and healthcare facility.”

Valentine leads a patient preoperative education class to help prepare patients for surgery and keeps tabs on their conditions or any questions they may have. “It gives [patients] an opportunity to ask a lot of questions through the whole continuum of care and through discharge,” she says. “The patients really want to share that experience, what they went through. It’s really amazing.”

Keeping patients informed is a significant part of the recovery journey for knee replacement patients, says Reed. Reed attributes the educational program as playing a role in increasing the patient load for knee surgeries at the hospital, from 100 in 2009 to 161 in 2010. Word spread in the community about the accessibility of the hospital to patients, she says.

Reed says that the educational programs have led to more patient referrals. Since the programs began, the hospital increased referrals by patients who are likely to refer others from 75% to 88%, she says. Ultimately, the goal is 95% or higher, she says.

The hospital issues 90-page guidebooks to help patients with the pre- and postoperative experience, Reed says. Patients receive the guidebooks, which have information ranging from instructions about preop to at-home exercises, when they are scheduled for surgery.

Reed acknowledges that the guidebooks are lengthy. “We want patients to answer questions they didn’t even know they had,” says Reed. “If they haven’t had surgery before, they might not know what to ask.”

In addition to the guidebooks, patients and their families attend a preoperative class to prepare for surgery and address questions not answered in the guidebooks, Reed says.


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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