Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Outpatient Joint Replacement
Mike Berend, MDMidwest Center for Joint Replacement
Indianapolis, Indiana
Clinical InnovationCost savings, early return to function and work,
higher satisfaction
Medicine is Dynamic • EMR• “Meaningful” use• Payer and Hospital
mergers• Payment advisory board• Medicare reductions• Regulatory “oversight”
SpeakingOf dynamicChanges…
New Beginning
www.mcjr.com
Timeline of Arthroplasty Length of Stay
0
1
2
3
4
5
6
7
8
9
10
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Ave
rage
Length
of
Stay
1991-1992♦Same protocol♦LOS: 5-7 days
1987-1990♦TKA: Robert Jones dressing♦THA: Charnley buttons♦All patients → Mini ICU ♦LOS: 7-10 days
1993-1997♦Same protocol♦Acute setting: 3 days♦Adjacent SNF: 7 days
1997-2002♦Regional anesthesia (epidurals)♦Soft tissue injections♦Acute setting: 3-5 days♦Outside SNF: 7 days
2003-2004♦Single shot spinals♦Rapid recovery protocols♦Multimodal medications♦LOS: 2.5 days
2005-2011♦Minimally invasive surgery♦LOS: 1.5 days
2012-2013♦Liposome bupivacaine suspension injection♦Same day surgery
From Keith R Berend, MD, JIS, Inc
Why Do Patients Stay in the Hospital?
1. Fear/Anxiety Unknown Pain
2. Risk Co-morbidities Medical complications
3. Side-effects of our treatment Narcotics/anesthesia Blood loss Surgical trauma
Hospital Environment Not Ideal
• “limited resources”• Multiple agendas• Resistance to change • Increased infection risk• Higher cost• Staff don’t report to
Surgeons…• Regulatory
environment Indianapolis Star Newspaper
Patient Selection for OutPt Arthroplasty• Medical screening program• “Acceptable” Cardiac History• Hgb > 12• Function Independently with Walker• Pre-op Visit and Physiotherapy Evaluation
– Pre-op Education & Equipment– Written Materials– Family Support at home
• Live within 1-2 hours of the center– 23 hour stay capabilities helpful but not
mandatory < 2%
Postoperative Care
– FWB: Walker or Crutches
– Cryotherapy– PT options
1. Home PT2. Outpatient3. Patient HEP
– 23 hr obs prn– ATI coordination of
care2 hrs s/p PKA
It’s Safe, It’s Better for Us and Our Patients, and It’s Here Now
• Actually spend more time with the patients and family in a more friendly environment– Typical Day: 6-8 Outpatient TJA– Average 9 interactions with patient/family
– Phone calls down
Clinical Experience Out-Pt Knee
• Began Sept 2011, Currently: > 80 %• 2 year data Q1 13’ to Q1 15’• 2,055 Knee Arthroplasties (CHKS/JIS)
(~ 50%)– 1,037 PKA– 983 TKA– 35 Rev TKA
• 98 % home DOS
Summary
• Future may reveal ideal marriage- All Arthroplasty and Outpatient Space
• MCJR national leaders in this space
• Focused on patient, their family, experience-‘Less is More’ ~ big scope
- We believe in Individualized Care for the patient and their care team
Thank You
www.mcjr.com