TY - JOUR
T1 - Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project
T2 - Phase I Outcomes
AU - Wyles, Cody C.
AU - Smith, Hugh M.
AU - Amundson, Adam W.
AU - Duncan, Christopher M.
AU - Niesen, Adam D.
AU - Ingalls, Lori A.
AU - Zavaleta, Kathryn W.
AU - VanDeVoorde, Robert A.
AU - Ryan, James L.
AU - Sanchez-Sotelo, Joaquin
AU - Taunton, Michael J.
AU - Perry, Kevin I.
AU - Mabry, Tad M.
AU - Abdel, Matthew P.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/3
Y1 - 2021/3
N2 - Background: This study aimed to improve institutional value-based patient care processes, provider collaboration, and continuous process improvement mechanisms for primary total hip arthroplasties and total knee arthroplasties through establishment of a perioperative orthopedic surgical home. Methods: On June 1, 2017, an institutionally sponsored initiative commenced known as the orthopedic surgery and anesthesiology surgical improvement strategy project. A multidisciplinary team consisting of orthopedic surgeons, anesthesiologists, advanced practice providers, nurses, pharmacists, physical therapists, social workers, and hospital administration met regularly to identify areas for improvement in the preoperative, intraoperative, and post-anesthesia care unit, and postoperative phases of care. Results: Mean hospital length of stay decreased from 2.7 to 2.2 days (P < .001), incidence of discharge to a skilled nursing facility decreased from 24% to 17% (P = .008), and the number of patients receiving physical therapy on the day of surgery increased from 10% to 100% (P < .001). Press-Ganey scores increased from 74.9 to 75.8 (94th percentile), while mean and maximum pain scores, opioid consumption, and hospital readmission rates remained unchanged (lowest P = .29). Annual total hip arthroplasty and total knee arthroplasty surgical volume increased by 11.4%. Decreased hospital length of stay and increased surgical volume yielded a combined annual savings of $2.5 million across the 9 involved orthopedic surgeons. Conclusion: Through application of perioperative surgical home tools and concepts, key advances included phase of care integration, enhanced data management, decreased length of stay, coordinated perioperative management, increased surgical volume without personnel additions, and more efficient communication and patient care flow across preoperative, intraoperative, and postoperative phases. Level of Evidence: III Therapeutic.
AB - Background: This study aimed to improve institutional value-based patient care processes, provider collaboration, and continuous process improvement mechanisms for primary total hip arthroplasties and total knee arthroplasties through establishment of a perioperative orthopedic surgical home. Methods: On June 1, 2017, an institutionally sponsored initiative commenced known as the orthopedic surgery and anesthesiology surgical improvement strategy project. A multidisciplinary team consisting of orthopedic surgeons, anesthesiologists, advanced practice providers, nurses, pharmacists, physical therapists, social workers, and hospital administration met regularly to identify areas for improvement in the preoperative, intraoperative, and post-anesthesia care unit, and postoperative phases of care. Results: Mean hospital length of stay decreased from 2.7 to 2.2 days (P < .001), incidence of discharge to a skilled nursing facility decreased from 24% to 17% (P = .008), and the number of patients receiving physical therapy on the day of surgery increased from 10% to 100% (P < .001). Press-Ganey scores increased from 74.9 to 75.8 (94th percentile), while mean and maximum pain scores, opioid consumption, and hospital readmission rates remained unchanged (lowest P = .29). Annual total hip arthroplasty and total knee arthroplasty surgical volume increased by 11.4%. Decreased hospital length of stay and increased surgical volume yielded a combined annual savings of $2.5 million across the 9 involved orthopedic surgeons. Conclusion: Through application of perioperative surgical home tools and concepts, key advances included phase of care integration, enhanced data management, decreased length of stay, coordinated perioperative management, increased surgical volume without personnel additions, and more efficient communication and patient care flow across preoperative, intraoperative, and postoperative phases. Level of Evidence: III Therapeutic.
KW - perioperative management
KW - perioperative surgical home
KW - surgical efficiency
KW - total hip arthroplasty (THA)
KW - total knee arthroplasty (TKA)
KW - value-based healthcare
UR - http://www.scopus.com/inward/record.url?scp=85091615227&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091615227&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2020.09.003
DO - 10.1016/j.arth.2020.09.003
M3 - Article
C2 - 32978023
AN - SCOPUS:85091615227
SN - 0883-5403
VL - 36
SP - 823
EP - 829
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 3
ER -