Trends in outpatient orthopedics + ASC post-op care: 3 Qs with Dr. Brian Busconi

Brian Busconi, MD, is an orthopedic surgeon and chief of the division of Sports Medicine at Worcester-based UMass Memorial Medical Center. He is also the medical director at The Surgery Center in Shrewsbury (Mass) where he also performs surgery. After a procedure, Dr. Busconi creates videos for his patients that detail his post-surgical instructions. Dr. Busconi spoke with Becker's ASC Review about the trends he's seeing in outpatient orthopedics, and the effect his videos have had on patients and the ASC.

Note: Responses have been lightly edited for style and clarity.

Question: What trends are you seeing in outpatient orthopedics?

Dr. Brian Busconi:  Increasingly, the movement is toward an outpatient surgical market. The reason behind that, first of all, is financial. We can bundle and negotiate with insurance companies by driving down the costs, and ultimately give a savings to the overall healthcare marketplace. Secondly, patients recover better at home. Their environment is more familiar and is more ideal for healing. Across the United States as the insurance companies are assigning codes to procedures that allow the ASC to do more and more outpatient surgery, we are moving in that direction as well. Here at our ASC we already have plans to perform arthroplasty in the knee and shoulder, and we are waiting for outpatient codes for hips. We are always looking to expand the scope of services that we can provide.

Another trend that we are seeing is to be able to provide patients options for treatment of articular cartilage and tendon issues in the body utilizing patients' own biologics, meaning that we are providing platelet-rich plasma and stem cell-based therapies for our patients in an outpatient setting.

Q: Has the ASC seen an impact from providing patients with a video to help them remember instructions after surgery?

BB: Absolutely. Anecdotally, I know my patients have been relieved that they can see and hear what happened in their procedure and be reminded of postoperative instructions in a moment’s notice by clicking on the video. These videos have led to approximately 60 percent fewer follow-up calls to the office from patients that are unclear about post-op instructions. While we, of course welcome, patients and loved ones to call back with questions or concerns at any time, the decrease in calls shows that patient education has been greatly improved by these videos.

 It is not an uncommon experience for patients undergoing day surgery to experience drowsiness upon waking up from the procedure in the recovery room and therefore sometimes have difficulty remembering the discussion that occurred from the healthcare professionals taking care of them. Because of the drowsiness, I thought to create a comprehensive communication for patients that included written instructions and a personalized video. I’ve found this initiative has improved patient satisfaction, their overall experience, and ultimately their surgical outcome.

The video is a supplement to the pre and postop care — it does not replace interpersonal communication between patients and caregivers, nor does it prevent patients from receiving hard copies of information if they prefer. We have found, however, that the vast majority of patients (even elderly patients) have constant access to email and actually appreciate receiving the personalized videos. The video itself includes intraoperative surgical pictures and postoperative instructions for when they go home, thereby allowing them to see what exactly took place in the procedure and how to best expedite their recovery.

Detailed instructions are also emailed with basic recovery recommendations. The feedback for the video was instantaneous and one of resounding positivity, as evidenced by many patients who have replied to the email with gratitude and appreciation. At the end of the day, the video takes all of a few minutes to complete but has shown tremendous benefits in improving patient education and decreasing stress and anxiety, including among loved ones who are responsible for providing care at home with little medical knowledge.

Q: What advice would you give to other surgeons who want to make videos for their patients?

BB: It would be my recommendation that all surgeons go on to utilize electronic media in their practice. Patient engagement is critical in terms of the overall success of the procedure; we’re just creating another mechanism to allow them to be engaged in their care and allowing us to get them the information that they need to have a successful outcome. If a surgeon isn’t as comfortable with personalized videos but still wants to utilize multimedia technology, another option is to create stock videos with generic information for patients.

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