Moving the needle from 23 to 6 hours: How this Illinois ASC gets patients up and moving after TJRs

Stepping into the nursing field in 1995, Tammy Blackburn, BSN, RN, has accrued a wealth of experience in different care settings. She practiced in hospitals for two decades before joining Rockford-based OrthoIllinois' team, where she currently serves as the ASC's director. The primary difference between a hospital and a surgery center, in Ms. Blackburn's opinion, is the ability to make changes quickly based on observed inefficiencies.

"We've changed our processes [for the program] a few times to make it better. We are a small group so we can come together and agree to start doing something," she says. "We have the ability to make decisions quickly about making something imperfect perfect."

Making the necessary decisions to drive optimal patient outcomes is crucial for the ASC's total joints program. Following a successful TJR procedure, OrthoIllinois' patients leave the facility between four hours and six hours thereafter. OrthoIllinois does not currently have the bed ability to keep patients for 23-hour stays. Therefore, the many moving parts of a patient's care team, from the anesthesiologist to administrative personnel, have to work collaboratively for the program to succeed.

First and foremost, the ASC staff members work to eliminate any variables that could compromise excellent patient outcomes. When the surgery center first launched its program, physicians used a local hospital's operating room as a testing ground to see if getting patients up and moving in that four-to-six-hour time frame was feasible.

"We tried it in the hospital setting to see if the program could work the way we wanted it to work," Ms. Blackburn says. "When we started the program, we only selected a few patients and kept our variables tight. We had the same anesthesiologist, the same surgeon and the same patient selection criteria, and it worked."

The surgery center's nursing staff, along with the physician staff, plays a large role in the patient vetting process. The surgery center's pre-admission nurses conduct in-depth interviews with patients to understand factors that impact their recovery. For instance, nurses ask patients if they have someone to care for them following surgery and meet with the patients at least 10 days pre-operatively to answer any questions and collect any needed labs. Other questions include assessing if a patient's home allows for mobility, if the patient has pets they have to care for and options for physical therapy.

"We do much deeper interviews than what patients may have in a physician's office," Ms. Blackburn says. "Our physicians do a great job screening patients. However, patients don't always tell certain details to physicians. We [nurses] ask them a variety of questions."

For every initiative, there is always room for improvement. Within the next 30 days, OrthoIllinois is rolling out an initiative to ensure all paperwork, labs, PT evaluation and risk assessment are completed 10 days before a patient has surgery.

"Patients should have their PT evaluation and home health set up. Everything should be completely done those 10 days prior to surgery or we will postpone," Ms. Blackburn says. "We realized this was a better practice and we need to make sure that when patients get home, they are in the best situation."

The overall goal of this initiative and every part of the evolving TJR program is to help patients and ensure their recovery is ultimately successful.

"[The most rewarding part of my job] is seeing patients up and walking an hour after they enter the recovery room and with minimal to no pain," Ms. Blackburn adds.

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