Nearly five years ago, Excelsior Orthopaedics in western New York began a journey to offer outpatient total hip and knee replacement at an ambulatory surgery center.
This content is sponsored by Johnson & Johnson Medical Devices Companies
Andrew C. Stoeckl, MD, board president of Excelsior Orthopaedics, and David J. Uba, CEO of Excelsior Orthopaedics, shared early patient outcomes from the practice's outpatient TJR program during a workshop at the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference June 14, 2018, in Chicago.
Excelsior Orthopaedics introduced outpatient TJR at its multispecialty ASC, Amherst, N.Y.-based Buffalo Surgery Center, three years ago after a year and a half of preparation. Since then, the surgery center has completed upwards of 330 TJR procedures. Ninety-nine percent of Excelsior Orthopaedics' outpatient total hip and knee replacement patients responded positively on care satisfaction surveys administered by the group during the past three years.
Here are three insights to Excelsior Orthopaedics' outpatient TJR success:
Data collection
Nationwide, TJR has become a more common outpatient procedure thanks to advancements in minimally invasive surgical techniques and pain management protocols. For Excelsior Orthopaedics, the first step to launching its outpatient TJR program was to consolidate resources.
"Standardization of care, care coordination and continuity of care — that's what creates the kind of quality that we've been able to accomplish [in our outpatient TJR program]," Mr. Uba explained. "It's our ability to marshal our resources and bring together our means of production … from the surgeon, to anesthesia, to the facility, to [durable medical equipment]."
To measure the program's outcomes, Excelsior Orthopaedics collected quantitative data on surgical site infections, complications and readmissions, among other metrics. The group also gathered qualitative data on patient satisfaction throughout episodes of care using electronic follow-up surveys at the two week, six week, three month, six month and 12 month marks. This was enabled with the use of CareSense.
"You're going to want to know your outcomes, you're going to want to know your data and you're going to want to know what your leverage points are to manage both quality and costs," Mr. Uba explained.
Postoperative care
A key component of Excelsior Orthopaedics' outpatient TJR program is an off-site surgical recovery suite. Physicians discharge patients from Buffalo Surgery Center to the recovery suite within an hour of surgery, where the patient receives services including on-site physical therapy, iPads for video chats with surgeons and 24/7 nursing care for one night.
After discharge from the recovery suite, patients return to Excelsior Orthopaedics for follow-up physical therapy and rehabilitation appointments on an outpatient basis for roughly 12 weeks.
A central mission
The care team at Excelsior Orthopaedics shares a central mission — ensure patients are able to safely and efficiently leave the surgery center on an outpatient basis and recover in the comfort of their own home, without experiencing an extended hospital stay.
"By the time the day of surgery comes around the expectation is set, so [the patient] knows they're going to have surgery, they're going to go to the recovery suite and then they're going to go home the very next morning," Dr. Stoeckl said. "There's no expectation that their stay will be extended." In the event they encounter a complication, there is an established protocol for patient care.
Mr. Uba highlighted the TJR program was made possible through a working relationship with DePuy Synthes, an orthopedic company that's part of the Johnson & Johnson Medical Devices Companies. DePuy Synthes provided Excelsior Orthopaedics with comprehensive resources, to lay the foundation for a successful program.
"It is the level of service and resources we can get from our partners," he said. "Look for relationships that can provide you with the resources and support that you need to establish a total joint program in an ASC."