Every person must buy-in — Dr. Nishant Shah on how to build an excelling outpatient total joint program

Outpatient total joint replacements will leap 77 percent over the next decade, while inpatient total joints will only see a 3 percent growth over that period, according to Sg2.

Anesthesiologist Nishant Shah, MD, medical director at Morton Grove-based Illinois Sports Medicine & Orthopedic Surgery Center and partner at Park Ridge, Ill.-based Midwest Anesthesiology Partners, shares his thoughts on what makes a successful outpatient joint program.

Question: What advancements have allowed arthroplasties to shift to the outpatient setting?

Dr. Nishant Shah: First and foremost, the surgical technique. The approach that surgeons are taking is such that the surgeries are less invasive and take less time. Their technique is much better and it's been refined over the years and fine-tuned to a point that surgeons are doing them so quickly and so well.

Patient selection is big, but a little bit of a sub-criteria to that, is that patients are getting younger. More people need arthroplasties and now they are 40 or 50 year olds.

On the other side, anesthesiologists have better technical skills and a better ability with which to provide anesthesia and pain control. More anesthesiologists now have the ability to perform procedures that reduce postoperative pain. [Also], physical therapy has evolved and it's able to offer patients therapy right then and there.

As a whole, people have understood the necessity for doing things in an outpatient setting, both from a fiscal perceptive and a social setting, where patients are motivated and do not want to be in the hospital for three days to three weeks.

In addition, you have outpatient facilities that probably provide an environment in which the infection rate is the same or lower than in the hospitals. As a whole, you have people who staff surgery centers that are different than in the past. The mindset now is that everyone has such a high level of training, they are able to provide such good care acutely.

Q: What factors should ASCs consider before adding total joints to their offerings?

NS: You have to have buy-in from every personnel group — administrators, nurses, nurse coordinators, anesthesiologists and surgeons. Every single individual that staffs the center has to buy-in and be invested in the process. If any chain doesn't do its part, the whole thing falls apart. It's a very comprehensive process that involves everyone. The patients have to buy in and be invested and motivated and have the appropriate support structure in their home.

Q: What makes a total joint center of excellence?

NS: You want to provide the best care to your patients no matter what procedure you're doing. You want to do what's in your patients' best interest and in a comprehensive way.

Surgeons see patient preoperatively and communicate with people at the center, and follow up with patients after.

Anesthesiologists have to do much more than we've ever done. We have to talk to the patient before hand, figure out if the patient is appropriate for the procedure. We have to make sure the patient is doing well enough to do their rehab, and be available to help in any which way if things go awry.

From a nursing staff, there is going to be more asked of them. These procedures require more work and more time.

Everybody has to realize that we have to work together as cohesive unit. It is not only the surgeon performing his duties while the anesthesiologist performs his; there has to be constant communication between all parties throughout the whole process, such that everybody is working together.

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