It takes a Team
The spectrum of orthopedic care is wide and highly specialized. While the navigators, nurses, orthopedic surgeons and therapists are the most visible components of orthopedic treatments, it takes the expertise of many additional clinical providers to offer the comprehensive care that we as a system demand and patients deserve. We have taken the opportunity to recognize some additional members of the team that contribute throughout the clinical experience to make our excellent patient outcomes a priority.
“Well” Before Surgery
Across the board, a patient’s general health is a concern both before and after surgery. For elective/scheduled surgeries, a designated Pre-Anesthesia Surgical Screening (PASS) can identify potential health issues and create a plan to manage the health issue that could affect, or even delay surgery. For elective surgeries, patients are advised to expect a call from the PASS Nurse for a health interview. In some areas a primary care physician or nurse practitioner may provide this screening. This pre-screening done before anesthesia provides an additional layer of safety, and another opportunity to help patients to be at their most optimal health before anesthesia and surgery.
Anesthesia and Medications
Both anesthesiologists and pharmacists focus on the goal of providing optimal pain control in a manner that keeps orthopedic patients comfortable and safe. Their open and innovative approaches to patient care have directly reduced the time a patient needs to be hospitalized.
Advances in long-lasting local anesthetics have provided newer anesthesia options that can dramatically decrease postoperative pain and recovery time after hip or knee replacement.
The focus on perioperative pain control and multi-modal analgesia allows the use of multiple agents to treat pain before it starts and continues through all phases of surgery. This can help to avoid narcotics and the unwanted side effects they can cause.
Sentara is moving toward surgeries that use regional anesthesia instead of general anesthesia. Regional anesthesia results in less grogginess and nausea, and patients can be up and moving the same day as their surgery. The results are showing in our patients’ decreased length of stays.
With the skilled inpatient therapy team, an overwhelming majority of joint replacement patients are up and walking the day of surgery, hastening recovery and allowing discharge directly to home. However, for patients who require short-term skilled rehabilitation therapy, Sentara offers the full continuum of care, including the new Sentara Rehabilitation & Care Residence. This newly constructed 120-bed facility features an innovative “household” design with 20 residents each, and a resident-centered approach to care currently in use at just 3 percent of skilled nursing facilities nationwide. It is also the first facility of its kind in Virginia to move beyond a trial phase to full implementation.
Hospitalists: Specialists in Managing Care for Patients During Hospitalization
Throughout Sentara facilities, surgeons have the resources to include a full-time hospitalist or other primary care physician to consult with any orthopedic patient in need of additional medical attention while hospitalized for an orthopedic procedure. Whether a medical issue develops following a procedure or it is a previously known comorbidity, the team rallies to manage the patient’s care. It’s part of the emphasis to keep patients at their optimal health to promote recovery as well as prevent readmission for a medical issue that can be addressed while the patient is in our facility.
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 benefiting from game-changing advances that include:
Sentara Fracture Care: Committing to operations for hip fracture patients within 24 hours: This approach significantly lowers mortality rates and blood clots (DVTs), with most patients up the day of surgery.
Standardizing nationally proven best practices at the 11 Sentara OrthoJoint Center® locations: This effort began in 2011 and continues to evolve and show excellent patient outcomes fueled in part from the patient interaction and education. For example, blood transfusions were reduced from 21.9% in 2011 to 3.4% in 2016. This resulted in nearly 1 million in cost savings over 5 years. (917k)
Limiting the use of narcotics with the adoption of pain management protocols: Our focus is on perioperative pain control (starting prior to surgery and continuing through discharge) and multi-modal analgesia (treating pain before it starts). This approach 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.
Implementing a comprehensive protocol 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.
Establishing and adopting DVT (deep vein thrombosis) prophylaxis protocol within each Sentara OrthoJoint Center® and system-wide: This protocol has been associated with significant reductions in the postoperative formation of clots in blood vessels (thrombosis) that can lead to severe complications and even death.
Financially Responsible Care
Bundled Payments for Care Involvement (BPCI) is a partnership program with Sentara and Remedy Partners™ to better manage and improve the health
of hospitalized Medicare patients. Patients are provided services at no additional cost that help to coordinate their care and control their health care costs. This covers care while the patient is in the hospital and extends through the recovery after the patient is discharged from the hospital. Participating patients continue to have the right to choose their health care provider.
A total joint replacement BPCI (program) was launched in 2016 with impressive results:
- Readmissions declined to 5.7% from a baseline of 10.8%
- Referral to Skilled Nursing Facility reduced to 35.2% as compared to baseline of 55.5%
- Referral to Home/Home Care was 53.6% as compared to a baseline of 40.7%
- Skilled Nursing Facility days 18.4, compared to baseline of 24 d
Lower the incidence of clots to less than 1% of patients at the majority of Sentara hospitals
(The target is 0.49% at Sentara Norfolk General Hospital because of its trauma designation.)
“I was worried about having surgery, because after an earlier one, I woke up experiencing post-traumatic stress disorder. I shared my concern with the staff, and the anesthesiologist took every precaution, allowing my wife and my daughter into the recovery room to comfort me and instruct the nurses on how to approach me so I wouldn’t become alarmed. It was the best care I ever had.”