Orthopedic surgery patients at UnityPoint Trinity Bettendorf (Iowa) Hospital are often walking around the same day as their surgery, and back at home well within two.
"At least 80 percent of our patients go home within a day of surgery," says John Hoffman, MD, the lead surgeon and part of the co-management team of the Orthopedic Surgery Program at Trinity Bettendorf.
The hospital sees over 600 orthopedic surgery patients annually, and has developed several best practices to get patients back on their feet more quickly.
Partner closely with physicians. In order to develop a successful orthopedic surgery program, "you really have to have a good collaboration with the physicians," says Betsy Demarest, director of surgical services at Trinity Bettendorf.
Trinity Bettendorf partnered with physicians for the initial implementation of the new procedures; administrators and physicians were educated together, and everyone was on the same page from the beginning, says Ms. Demarest. Currently the responsibility for managing the orthopedic program is split between the hospital and the physicians, she says.
"The biggest lesson [for other hospital administrators] is no one can do it by themselves — neither hospitals nor physicians," says Ms. Demarest. "You could put together a program as a hospital, but if you don't have a partnership with your physicians, it won't be nearly as effective," she says.
Provide comprehensive patient education. Prior to surgery, patients at Trinity Bettendorf go through a "boot camp" to learn what to expect before, during and after the procedure. The program is "designed to prepare the patients for what they'll experience at the hospital plus what they can expect postoperatively at home," says Ms. Demarest.
During the boot camp, "nurses talk about what's going to happen, and the patients are given a journal to use postoperatively that's created with physical therapy in mind," she says. "It contains a check-off list with different mile markers that a patient needs to meet to be discharged."
"We also always encourage a patient to have a coach [with them during the 'boot camp'], a husband or wife, or other caregiver. We've found that it helps in having our instructions remembered — if a patient only remembers three-quarters of what was said, hopefully their coach remembers the other quarter," says Ms. Demarest.
"It's been very helpful to teach patients ahead of time what to expect," says Dr. Hoffman. "People then go into surgery with clear expectations."
Help patients reduce risk factors. "We make sure all patients are medically cleared for surgery at least three to four weeks before the procedure is scheduled," says Dr. Hoffman. By testing patients early, interventions can be made if a patient has a condition that would increase their risk of a surgical complication.
For example, Dr. Hoffman says he sees many diabetic patients who are noncompliant with their diabetic management, and whose high glucose levels place them at elevated risk for complications. "An upcoming surgery allows us to send them to an endocrinologist that will see them for six weeks before and for six weeks after the surgery" to ensure that their diabetes is under control during their most vulnerable time, he says.
"Even a patient who's poorly compliant about their diabetes management can be talked into becoming better compliant for a 12 week period," says Dr. Hoffman.
Medicate with a focus on speedy recovery. Being able to send patients home within two days of joint replacement surgery is "very dependent on both the surgeon and the perioperative medication," says Dr. Hoffman.
During surgery, Dr. Hoffman uses local, instead of general, anesthetic. "If surgeons rely on general anesthesia, many patients don't recover quickly enough to go home the day of their procedure," he says.
He also does not use IV morphine, only oral medications. "The IV morphine makes them drowsy, increases nausea and delays physical therapy — all of which are barriers to leaving the hospital after surgery
"Patients are very comfortable after surgery," he says, and are often up and walking around hours after the procedure.