Becker's ASC Review

66 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Business of Spine - call (800) 417-2035 Four surgeons speak about trends in total joint replacement in the ASC setting. Q: To successfully bring total joints to an outpatient setting, what procedures and protocols must be in place? Chad Burgoyne, MD, The Spine & Orthopedic Surgery Center (Santa Barbara, Calif.): The most important factors in performing a joint replacement as an outpatient proce- dure are the coordination and protocols that allow the surgi- cal team to provide streamlined service. The surgical team needs to be consistent and well trained in joint replacements; the shorter the surgical time, the less pain and subse- quent anesthesia is required, and the more the patient is able to participate immediately in therapy comfortably. Second is the anesthesia team. With a combination of spinal, regional and local anesthesia, we are now able to have postoperative patients that need little to no pain medication in the first days after surgery. The nursing staff must also shift their focus to enable the efficient discharge of patients. Their role is as much coach as caregiver. They must care for, edu- cate, facilitate and encourage all in one breath. All the resources and steps must be in place so they can focus on the task at hand. Finally, there is the therapy team. The therapists must organize their days around the operating room schedule to minimize down time. A patient cannot be allowed to sit in bed and simply "recover." The therapists must be available to start ambula- tion within the first hour after surgery is complete. Charles A. Hope III, MD, Optim Orthopedics (Savannah, Ga.): An experienced and cohesive surgical team is required for an efficient TJA practice, whether the operation is inpa- tient or outpatient. Also, a consistent message must be deliv- ered at all points along the way to mold appropriate patient expectations. The flow from entry to exit must be smooth, predictable and expeditious, and experienced team members must be available to provide routine postoperative monitoring and to trou- bleshoot any issues that arise. Matt Riordan, MD, Ambulatory Surgery Center of Stevens Point (Wis.): In terms of the facility, you must have ap- propriate OR size, (INR checks, SCDs), the capacity for ex- panded equipment, sterilization equipment, a hospital bed, a reclining chair, medications for pain and an injectable block mix, a sterile set-up space, the Institute of Healthcare Im- provement's standard preparation, antibacterial irrigation, space suits and an effective infection prevention program. In terms of the payer, the ASC must demonstrate safety, competency, lower costs, market demand, the non-experimental nature of the care, the organi- zation of process and preapproval. Mark Scioli, MD, NorthStar Surgical Center (Lubbock, Texas): To successfully bring total joints to an outpatient setting, one must be sure the patients are properly selected, home care and assistance and therapy are arranged and pain management as well as deep vein thrombosis prophylaxis is coordinated. In addition, there must be clear lines of com- munication open to the facility, the surgeon and his or her staff during the patient's stay as well as after discharge. Home care should be arranged with protocols well understood by the nurs- ing agency. Durable medical equipment should be pre-arranged and in place. Staffing for total joint cases should be part of each facility's effort to deliver the highest level of care. Q: how can surgeons set themselves up for success for total joints in the outpatient setting? Dr. Hope: The journey to outpatient TJA begins with developing an efficient, high-volume arthroplasty practice. Once inpatient stays are reduced one or two nights, then the concept of a 23-hour program is a small step, rather than a giant leap. True outpatient procedures without an overnight stay are possible but are probably better limited to those completed prior to noon. While the surgeon, anesthesia, support staff and facility are all important, patient selection is crucial. The ideal patient is younger, healthier (medically and mentally), probably more educated and must have a reliable home sup- port network. Patients with major medical issues, chronic narcotic use or those with inadequate help at home should be excluded. Dr. Burgoyne: The team-oriented protocol is the key to success in outpatient joint replacement. On the day of surgery, a surgeon can only be responsible for what happens in the operating room. The rest of the process needs to run on "autopilot." In fact, a process such as this should actually be driven by the facility, not the surgeon. Protocols must be in place well before the time of the procedure. At the end of the day success depends on the process not the individual. What Will it Take for Total Joints to Succeed at ASCs? By Ellie Rizzo For more information, call 425-657-0494 or visit our website at www.eveia.com Eveia's Clients: · Ambulatory Surgery Centers · Surgical Hospitals · Health Systems with ASC Relationships · Physician Practices · Anesthesiologists ASC Operations Compliance & Consulting Services Preparing for excellence Provider Business Services Optimizing opportunity Provider Contracting Services Reimbursement experts

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