From pre-op to post-op: A team-based approach to adding TJR to an ASC

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Healthcare is continuing to demand lower costs and optimal patient care, thus driving the demand for efficient ASCs. Outpatient centers are increasingly adding new procedures, including total joint replacement procedures.

Benita TapidBenita Tapia, RN, CASC, has served as Beverley Hills, Calif.-based 90210 Medical Center's administrator since it opened in 2006. The multispecialty ASC offers patients various specialties including spine, orthopedics, general, podiatry, urology, gynecology, ophthalmology, plastics and most recently, TJR.  

Pre-implementation steps
90210 Medical Center started plans to add TJR nearly a year ago, and assembled a team to put that plan into action.

"A great surgeon makes all the difference and we knew someone who was creating terrific outcomes at a nearby hospital who we could work with," Ms. Tapia says. "From there we put the team together."

90210's team includes an anesthetist, director of nursing, physician's assistant, physical therapist and patient-physician coordinator. As administrator, Ms. Tapia's goal was to organize the team and ensure everyone met their specific responsibilities to launch the program. For instance, whereas a surgeon is primarily responsible for bringing in cases, a director of nursing heads staff education.

Guiding the patient from pre-op to post-op
Most ASC procedures are elective, and therefore ASCs can choose viable candidates for surgery. 90210 accepts healthy patients to reduce the chance of infection. Additionally, patients' procedures are not rescheduled for emergency procedures, which can often happen in hospitals.

Teamwork is an essential part of the total joint program, and the patient can see 90210 staff members striving to work together through the entire surgical process. "Pre-op starts in the surgeon's office a few weeks before the procedure," she says. "Patient education, including pre- and post-op education and home environment evaluation, is a major part of our joint replacement policies."

Pre-op education is a critical component of the total joint program to ensure the ASC can discharge patients the same-day of the procedure. Prior to surgery, staff members tell the patient:

•    What they can expect
•     Analyze the patient's home environment to ensure it is suitable for a successful recovery
•    Go over the physical therapy plan
•    Check their medications

The center also utilizes spinal blocks and adductor canal blocks, resulting in reduced nausea and pain for the patient.

"This translates to less narcotics, which translates to less nausea and less hypotensive issues," Ms. Tapia says. "Patients are more comfortable to go home with this approach."

Working toward quality outcomes
Since implementing the program, the ASC is continually striving to improve quality and outcomes for patients undergoing TJR. 90210 integrated HealthLoop technology, a Mountain View, Calif.-based patient engagement solution. The technology helped the ASC automate patient education as well as record quality measures.

"90210 is on the forefront of advancing innovative ways that are engaging patients with surgeons and their care team," says Ms. Tapia. "Through HealthLoop's automated patient engagement, patients get guided care plans and answer questions about how they are doing. We're getting good, consistent data about patient outcomes and any problems that may emerge in the days and weeks after surgery."

Reporting is essential, especially because CMS does not approve TJR in an ASC setting. Through detailed reporting, ASCs can continue to demonstrate their success to CMS in addition to improving their center's internal processes and outcomes.

Next steps for 90210 include working with The Joint Commission to receive specialization certification for ASCs performing TJR. The center also aims to make intraoperative radiation therapy a "one-time thing in an ASC setting."

90210 has started assembling a team to assess if IORT can successfully work in an outpatient setting. Like TJR, a strong team is at the crux of any successful program.

"Every administrator should know that you can't do it alone," says Ms. Tapia. "Putting the team together is the very first step."

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