Becker's ASC Review

103 Executive Briefing: Sponsored by: T hree years ago, Michael Joyce, MD, noticed total joint replacement patients were mobilizing more quickly than in the past. Advanced surgical technology and new pain management techniques meant patients had shorter recovery times and hospital stays. They asked the question: What if these cases could go outpatient? Dr. Joyce and his colleagues began to perform some of their total joints as outpatient procedures at the hospital to develop an efficient process for patient selection, surgical flow and postoperative discharge. They used a resiliency score for patients based on responses to six questions measuring whether they had the temperament for outpatient surgery. "We started thinking about our patients not just in terms of their risks with diabetes or risk for infection, but instead thinking about whether our patients have a robust personality," said Dr. Joyce. "You have to understand the patient's mindset and how the evolution from the inpatient to the outpatient setting will be perceived differently." The surgeons also collaborated with anesthesiologists to use long-acting local anesthetics and limit narcotic use so patients would be discharged home in relative comfort. The last step was having patients undergo their initial physical therapy shortly after surgery. The process worked, and after successfully performing outpatient total joints for several years at the hospital, the surgeons decided it was time to take their cases to an ASC. Dr. Joyce and his partners collaborated with St. Francis Hospital to develop Lighthouse Surgery Center in Hartford, with assistance from outside vendors, including Stryker. Dr. Joyce had used Stryker implants for more than 25 years , but as he worked to develop the ASC, Stryker was much more than a pure implant vendor; they became a true partner, providing guidance for inventory management and design advice based on best practices. "I think of Stryker now as a company that provides both products and services to help make your ASC a reality," said Dr. Joyce. "When we want to buy a knee replacement implant, we go to Stryker. But developing a surgery center requires a lot of expertise and it's great to have those services as well. As a surgeon in the operating room, we aren't always thinking about the surgical booms, lights and stretchers. Having Stryker come to the table with so many different ideas gave us a higher degree of expertise." Over the past three years, the surgeons saw the volume of outpatient cases grow from dozens to hundreds annually. Then, COVID-19 accelerated the migration of total joints to the ASC. "Patients didn't want to be in the hospital," said Dr. Joyce. "We were COVID-free and became a safe alternative. " Once surgeons and patients became familiar with the ASC setting, there was no turning back. Dr. Joyce anticipates continued movement of total joints to Lighthouse Surgery Center and predicts similar ASCs will continue to emerge across the U.S. Steps for success To move a high volume of total joints from the inpatient hospital to outpatient ASC setting, organizations need strong leadership to build a collaborative culture, said Dr. Joyce. Surgeons must have the ability to discuss challenges with each other and the larger surgical team, especially if they are coming from separate independent clinical practices. The surgeons also need an extreme focus on clinical data. "Beginning at CJRI at St. Francis Hospital, the team started sharing results of all surgeons together and then broke that down to show individual surgeons' results and collaborated to improve those results individually and as a group," said Dr. Joyce. "That process unfolded over several years and allowed us to become very comfortable with it. The standardization of best practices wasn't a threat to anybody; instead, it was a way for everyone to deliver much better care." The surgical team also pays close attention to cost metrics to deliver the best care at a lowest cost. The team aims to invest in new technology to improve care and cut unnecessary spending when it doesn't lead to the best outcome. It is also helpful for ASCs to replicate processes from the hospital so surgeons feel comfortable making the move. Anesthesiologists have to be on board with taking surgeries to the ASC and agree upon patient selection criteria. Dr. Joyce and his partners regularly communicate about patients with anesthesiologists before the day of surgery to make sure the case is in the right setting. From products to partnership - how the right relationship can lead to ASC success The critical partnership that led to the successful transition of inpatient total joint surgeries to Lighthouse Surgery Center

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