Team Approach to Care
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.
- Surgeons at Sentara are 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 with seven locations, including Sentara Rehabilitation & Care Residence in Chesapeake which opened in the spring of 2017. Designed to feel more like home, this innovative household model of care features 120 private rooms, 40 of which are for short-term rehabilitation in the Great Bridge Pavilion. This dedicated area for rehabilitation provides personalized care, therapy seven days a week, low noise practices, and 24/7 dining. Some of the conditions treated are orthopedic procedures (hip, knee and joint replacements), post-surgery recovery, pulmonary impairments (COPD, pneumonia, etc.), cardiac conditions, fall-related injuries, neurological conditions and strokes. The Sentara Neurosciences and Orthopedic teams partnered with Sentara Rehabilitation & Care Residence to develop a Center of Excellence program for our back and neck patients. Through this partnership, the acute and post-acute care teams have developed a comprehensive and planned course of treatment for these patients.
Specialists in Hospital Care: Hospitalists
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 could have been addressed while the patient was in our facility.
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. Our orthopedic teams constantly set the standard for excellence in our regions and beyond.
- Implementing the Sentara Fracture Care program and our commitment to operations for hip fracture patients within 24 hours: We know the dedication of the orthopedic surgeons and staff to this benchmark of care 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.
- Using 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 systemwide: 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.
Rapid Recovery Protocols
Sentara orthopedic care teams continue to evaluate methods of care that help patients to recover more quickly. Along with the surgical precision and innovation, there are numerous practices that are effective in helping our patients’ progress through recovery and back to enjoying everyday activities:
- Preoperative education to prepare patients and their caregivers to set expectations and goals for recovering from surgery.
- Encouraging patients to be at their best physical health prior to any elective surgery by stopping smoking, starting pre-surgery exercises to strengthen muscles for recovery after surgery, and preparing the home as a clean, healthy place to recover.
- Exchanging addictive opioids for multi-modal pain management, including non-addictive pain medications, day of surgery physical therapy that gets patients up and moving, and an attentive care team that helps patients to keep ahead of post-surgical pain. When pain is at a tolerable level, patients are more able to move, participate in therapy and reduce the risk of developing a blood clot.
- Something as simple as having elective surgery patients to wear their own clothes in the hospital gives patients the sense of normalcy that motivates them to get up and moving.
Financially Responsible Care
In 2016, Sentara joined in partnership with CMS to better manage and improve the health of hospitalized Medicare patients. This initiative, BPCI (Bundled Payments for Care Involvement) is a voluntary program offered by CMS to improve the care and costs for patients over a 90-day time period following discharge from
Patients are provided services at no additional cost that help them to coordinate their care and control their healthcare 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 healthcare provider. The total joint replacement BPCI (program) has seen some impressive results.
The data below reflects a portion of the Medicare population that meets the criteria for BPCI:
- Readmissions declined to 5.7% from a baseline of 10.8%.
- Referrals to Skilled Nursing Facility reduced to 35.2% as compared to baseline of 55.5%.
- Referral to Home/Home Care increased to 85.1% compared to baseline of 53.6%.
Across the board, a patient’s general health is a concern both before and after surgery.