Good Samaritan Hospital Zero in on Zero:Improving Joint Replacement Outcomes

Mark Snyder, MD, Medical Director, Orthopedic Center of Excellence Kathy Eten, BSN, RN, CCM, Program Administrator, OCEBob Pritts, Administrator, Musculoskeletal and Rehabilitation Services

PROJECT SELECTIONPrediction that Total Hip and Total Knee demand will increase between 18.6 – 69.4% by 2016Delays in surgery will result in poorer outcomesIncreasing disease burden on the health care systemStrategic decision to focus on musculoskeletal service line, construction of dedicated unit in 2007 and hiring of

Medical DirectorDesire to pursue clinical excellencethrough disease specific certification

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SITUATIONAL ANALYSISFocus on improving clinical and service outcomesIdentified the top 10 most important areas of clinical focus to strengthen the program.Performed a causal event analysis of adverse events utilizing a before, during and after approach using extensive review of current literatureIdentified and implemented strategies before, during and after surgery to decrease adverse events Used consensus decision making to gain physician support and compliance with implementing best practicesTargeted zero as the goal for all adverse events

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PROJECT SOLUTIONS

Review of evidence using the before, during and after modelMulti-disciplinary team of current staffUsing current physician structure to review and approve strategiesImplementation of solutions using PDCA and small tests of changeSharing successes and failure by established communication vehicles and consistent messaging by Program Administrator to all groups

TARGETING ZERO!!

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PROJECT RESULTS

Prophylactic Antibiotics 100% within 1 hour for the last 4 monthsZero joint infections in 452 cases February – June 2011Blood utilization decrease from around 20% in July 2009 to less than 5% and still going down. Overall patient satisfaction has improved from the HealthStream 73rd percentile to the 80th percentile Patient satisfaction with pain management by staff has improved from the HealthStream 78th percentile to the 90th percentileFall rate has decreased by 50%Received Joint Commission Disease Specific Certification for Hip and Knee Replacement in March 2011. Only one in Greater Cincinnati. Received Blue Distinction, United Premium Specialty Care Designation and Aetna Institute for Quality all in 2010.

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