2015-16 Sentara Orthopedics Annual Report

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Sentara OrthoJoint Center®

The singular focus of the Sentara OrthoJoint Center® is the needs of orthopedic surgical patients undergoing hip or knee joint replacement surgeries. All locations of joint replacement centers concentrate their efforts on a dedicated team approach among nurses, anesthesiologists, surgeons, physical therapists and home care. This centered approach improves both patient care and outcomes and has helped us provide surgical options for patients who have been denied care elsewhere.

Setting the Standard:
Improving the Patient Experience

The success and expansion of Sentara Orthopedics is a direct result of our dedication to improving the patient experience. We’ve implemented countless measures to improve both overall care and treatment — from the initial consultation to postoperative care and beyond. We don’t just follow the crowd; instead, we constantly set the standard for excellence in our regions and beyond. Right now, our patients are benefitting from game-changing advances that include:

  • The adoption and standardization of nationally proven best practices at the five original Sentara OrthoJoint Centers® (2011-2014): showed earlier patient interaction and education, resulting in 54 percent fewer blood transfusions and a total cost savings of $202,3981.
  • The Sentara 2014 CEO Award recognized joint replacement centers at Sentara hospitals with the highest award for quality and innovations in Sentara.
  • Limiting the use of narcotics with the adoption of pain management protocols. Our focus is on perioperative pain control and multi-modal analgesia. This includes the use of medicines that work on pain receptors everywhere in the body, resulting in less nausea, less confusion and a significant decrease in patient recovery time.
  • Comprehensive protocol implemented for infection prevention and MRSA screening: Coupled with pre-surgery screenings for anemia and malnutrition, this protocol has significantly improved patient outcomes by lowering infection rates.
  • Specialized Orthopedic Nurse Certification (ONC) increased: Sentara OrthoJoint Center® is committed to the advanced certifications of our nurses. In 2015, 37 additional nurses completed their training to become eligible for the ONC exam.
  • The establishment and adoption of DVT (deep vein thrombosis) prophylaxis protocol within each Sentara OrthoJoint Center® and systemwide: This protocol has been associated with significant reductions in postoperative venous thrombosis (when a blood clot occurs within a blood vessel, leading to severe complications, including death).
  • Sentara has a systemwide initiative of reducing post-op VTEs (venous thromboembolism). By 2015 year end, all 11 Sentara hospitals performed at or lower than the tri-state region benchmark median of 0.26 percent and Sentara Norfolk General Hospital performed at 0.49 percent.
  • A dedicated Orthopedic Patient Navigator: The Patient Navigator helps foster open lines of communication between the patient, the patient’s family and the care team before, during and after surgery.
  • Nationally recognized Hypotension Protocol: This physician-developed and nurse-initiated protocol is a streamlined method to deal with potentially dangerous low blood pressure. Adopted across all Sentara OrthoJoint Center® locations, in just one year, the protocol single-handedly reduced medical interventions due to low blood pressure by 34 percent at Sentara Leigh Hospital. This Hypotension Protocol was presented at the national conferences including the 33rd Annual Congress of National Association of Orthopedic Nurses and the American Association of Orthopaedic Surgeons, 2014.

1 Sentara volume and data sourced from Sentara Decision Support

Graphic-ExpressTrack-bookThe Express Track option was introduced in 2015. It combines the high quality care of the Sentara OrthoJoint Center®, coupled with a shortened hospital stay. Patients leave the hospital the day after their joint replacement surgery and continue recovering in the comfort of their own home. There, they may be visited by our expert team of home care providers if needed.

Express Track is an optional program that requires the recommendation of the orthopedic surgeon and a commitment from the patient. To prepare for their Express Track participation, patients receive preoperative education and information, including a patient and family guidebook that lets them know what to expect. The guidebook also provides patients with both preoperative and postoperative exercises and expectations regarding recovery.

Express Track gives people who are highly motivated and healthy an opportunity to get better faster.

— Dr. Thomas Markham, orthopedic surgeon
express-track-fifty-one-iconGetting patients up and walking with physical therapy the same day of surgery is a key component to the success of the Express Track program. In its first year, 51 patients chose the Express Track option.



Making a Difference in the Patient Experience

Sentara Orthopedic Patient Navigators are nurses with specialized training in orthopedics, helping them provide an extraordinary level of patient care in their role as liaisons between the patient, the physician and the hospital. The Patient Navigator assesses patient needs and provides personal, individualized care for joint replacement patients. Orthopedic Patient Navigators are available at all Sentara joint replacement centers.

Sentara Patient Navigators see patients multiple times each day while in the hospital and serve as a touchpoint for the patient and the patient’s family. They help ensure that patients are properly prepared for surgery, including:

  • Preparing patient for surgery through education at a preoperative education class;
  • Understanding each patient’s medical history and risk factors (making sure, for example; that a patient’s diabetes is being properly managed) and;
  • Coordinating aspects of a patient’s care while in the hospital and after they leave.

We evaluate each patient to make sure they are at their best level of health. Many of our patients have joint replacement surgery in the morning and are ready to go home the next day

— Dr. Michael Higgins, Medical Director, Orthopaedic Hospital at Sentara CarePlex



This dedicated phone line assists people with joint pain. Over 1,000 people have called to talk directly to our Registered Nurse about their orthopedic health concerns and to get connected with an orthopedic specialist.