Excelling at Total Joint Care

Dominican Hospital Achieves Its Goal of Establishing a Comprehensive Orthopedic Care Program

Five years ago this fall, a team of medical professionals came together with the goal of creating a center of excellence for orthopedic care at Dominican Hospital.

Now, it bears stating: “Mission accomplished.”

Over the past five years, domincan’s orthopedic team has worked closely together in setting goals for and evaluating the results of every single patient who has entered the hospital for a total hip, knee, or ankle replacement.

Made up of representatives from 15 different areas of the hospital – admitting, administration, anesthesia, home health, nursing education, nurse navigator, occupational therapy, orthopedic nursing, operating room, orthopedic surgeons, physical therapy, recovery room, pharmacy, pre-admission testing, and surgery scheduling – the team meets at least twice a month to examine the program. It focuses on improving the quality of care, the functional outcomes of the patients, and the patient’s overall experience.

Nicholas Abidi, MD, an orthopedic surgeon whose practice OrthoNorCal is based in Capitola and includes colleagues Christian Heywood, MD, and Peter M. Reynolds, MD, played a pivotal role in creating the program. He attends weekly meetings as part of the management team.

“Our goal with the Total Join Care Program is to provide comprehensive care – by this we mean care before, during, and after surgery,” Dr. Abidi said. “A critical piece, and something quite unique to Dominican, is making sure our patients are thoroughly educated, not just about the procedure, but about all the resources available to them throughout the process. The knowledge our patients have going into and coming out of their surgeries has a big impact on the success of the procedure and on recovery time.”

Prospective patients attended a free Total Joint Care Program class to meet the team as well as have their functional abilities measured. In attendance is Dominican’s Orthopedic Patient Navigator Catherine Lawhorne, RN, who is available to patients throughout the surgical experience to answer questions and put them at ease.

“Many of the patients who need to have this kind of surgery are otherwise very healthy, so I’ve found that their exposure to the medical system has been limited,” Ms. lawhorne said. “My role as a navigator is to help them understand how the system works and be their go-to person if they have any questions or issues, even months after their surgery.”

Ms. Lawhorne estimated that she has up to 10 patients in any given week and credited the entire team with fine-tuning the program over the years to ensure that targets established for high quality care are met.

“We meet monthly as a team with these surgeons,” Ms. Lawhorne said. “That gives us the opportunity to discuss what’s working and what could work better. We’re always looking for best practices.”

Some of the targets the team aims for relate to decreased pain, early ambulation (return to normal movement), decreased length of stay, and discharge to home, according to Karen Gosling, MPT, director of rehabilitation, community health and wellness education at Dominican. she credited Dr. Abidi for initiating the new approach to pain management with anesthesiologists Zaheer Zaidi, MD, John Fox, MD, Steve Plumb, MD, and Edward Herold, MD.

Dr. Abidi has done considerable research on pain protocols and narcotics, using data from his prior practice, the Rothman Institute in Philadelphia, Rush University Medical Center in Chicago, and Mayo Clinic in Rochester, Minnesota.

“A major area of focus for us has been proper pain management,” Dr. Abidi said. “Poor post-operative results have a lot to do with pre-operative narcotics. Data has shown that anesthetics used during surgery have needed to be much stronger when major painkillers were used before an operation. Our program prescribes a more conservative pain management regimen before surgery to ensure the best outcomes post-operation.”

Results from this new approach:

• Patients experiencing pain that limited their ability to get up and walk with therapies early on after surgery decreased from just under 30 percent in the first year to less than three percent.
• Patients getting up and walking with therapies on the day after surgery increased from 83 percent to 91 percent.
• Patient discharged directly home instead of to another care facility increased from 45 percent to 90 percent.

Ms. Gosling said that it’s the personalized attention patients receive that differentiates Dominican from some larger medical centers doing the same surgeries. “We take care of you here all the way through the entire process – from the decision to first have surgery all the way through and past recovery,” she said.

“A key part to delivering the best pain management protocols is ensuring that all the staff have the most up-to-date education,” Ms. Gosling continued. “Clinical nurse educator Danielle Brooks is one of the orthopedic clinical nurse specialists at Dominican and a key member of the team. Danielle helps drive nursing best practices on the unit and ensures that the patients receive the right education to empower them to take control of their care.”

In part because of the passion and commitment shown for the program by all team members, Dominican Hospital has received the following recognition for its Total Joint Care Program:

• Designated a Blue Shield Distinction Center for Excellence for Hip and Knee Joint Replacement in 2012.
• Received the Healthgrades Orthopedic Surgery Excellence Award and the Healthgrades Five Star award for Total Knee Replacement in 2013.
• Received the Healthgrades Patient Safety Excellence Award in 2014 and 2015.
• Received the Healthgrades Five Star Award for Hip Replacement in 2015.

The program recently introduced a Total Joint Care Program Class Reunion, which will be held twice a year for patients who are at least six months recovered from their surgery. At the reunion, patients have their functional abilities measured once again, just as they did at the very first class.

“if you’re going to have a program, it has to be comprehensive,” Ms. Lawhorne said. “You need to know at what point you started from and how far you’ve come. Measuring the functional abilities of patients at the reunion allows both the patients and the team to capture the true impact of this program.”