Preparing for a total joints program: Key considerations for ASCs

More ASCs are looking to establish a total joint replacement program due to advancements in medical technologies and a push for more affordable healthcare.

However, ASCs need to consider several steps before building a total joints program, according to Marvella Thomas, a senior consultant with Dublin, Ohio-based Cardinal Health.

Here, Ms. Thomas discusses how ASCs can prepare to add a total joints program, outlines some common pitfalls that ASCs encounter and offers tips to avoid those issues.

Editor's Note: Responses were edited for length and clarity. 

Question: What is the first thing an ASC should do when looking to add a total joints program?

Marvella Thomas: The first thing an ASC should do is assemble a multidisciplinary team to analyze resources and develop an implementation plan. The team should consist of key stakeholders, including surgeons, anesthetists, preoperative and postoperative nurses, materials managers, business office managers and sterile processing employees. And of course, the administrator and other leadership folks should be involved, as well. Once this multidisciplinary team is formed, stakeholders can begin to develop the strategy and implementation plan.  

Q: What else can ASCs do to prepare for adding a total joints program?

MT: ASCs need not only the right people for a total joints program, but also the right equipment.  When it comes to analyzing resources, ASCs should look at their equipment and supplies to determine what supplies they will still need. This requires speaking with stakeholders to understand the details of the surgery, including what positions the patient will be in during surgery, and if they have the right tools or tables currently. Additionally, ASC leaders need to do a walkthrough of their facility to look at the size of their rooms, where the equipment will be stored when it isn't in use and where the equipment will be in the room when it is used. They should also look at storage for the additional supplies that they'll need to bring in. If they are already doing orthopedic procedures, there is probably not a lot of additional instrumentation and supplies they are going to need, but there are going to be some. They should also look at the resources in the sterile processing department.

In addition, surgical centers should look to establish protocols with key stakeholders. For example, an ASC will need to determine if patients need a special preop shower or if they will need nutritional supplements before surgery. If they are giving patients supplies before surgeries, do the nurses know so they can help educate the patient about those items? How will patients obtain those supplies? These are the types of questions that need to be ironed out before implementing a total joints program. 

Different protocols need to be established for post-op, as well. Some key questions to consider are: What does the patient need to accomplish so they can be successfully sent home? Are those post-op folks educating the patient's family about how to provide some of the initial care in the first 24 to 48 hours after surgery?

Q: You have helped a lot of facilities establish total joints programs. What is the most common pitfall ASCs encounter?

MT:  One of the biggest pitfalls is overlooking the sterile processing department. A lot of facilities are not considering the resources they'll need to pull all of the instrumentation together and sterilize it, because they are more focused on the operating room or the surgeons' needs. I have been in facilities that have implemented total joint procedures and don't have a large enough sterilizer to accommodate several orthopedic instrument trays at one time. That is extremely important, especially from an infection prevention standpoint. Making sure that ASCs include the sterile processing department in their discussions and planning is critical to the success of a total joints program.

Q: How can ASCs avoid common pitfalls?

MT:  I think the most important thing is teamwork. It is critical to ensure that all stakeholders are involved in the planning, not just the obvious ones. Another piece of advice I'd offer is that it is really important that ASCs talk with their peers. There are a lot of great articles out there that discuss what went well and what didn't work when implementing a total joints program. Doing a search about different facilities that have already implemented a program is helpful. If you tap into that network, there are great resources out there that can make the organization much more successful. 

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