Orthopaedic surgeons at Brigham and Women’s Faulkner Hospital now offer outpatient partial knee replacement and outpatient total hip replacement surgery, allowing patients to return home on the same day as their surgery. For the members of the multidisciplinary care team that interacts with the patient from the time they are admitted for surgery in the morning until they are discharged early in the evening, this means working together seamlessly to ensure the patient is fully prepared to go home at the end of the day. It’s a challenge that the team here at BWFH has mastered—in fact, they recently celebrated 60 successful same-day joint replacement cases with no readmissions!
Patients who have met the criteria for same-day joint replacement services are given detailed instructions on how best to prepare for surgery and what to expect when they go home from the hospital. Their cases are scheduled in the morning, allowing them time to recovery on an inpatient unit for much of the day. There they recover from anesthesia, receive education from their nurse and are tested by physical therapy to ensure they will be safe when it’s time to go home around 8 pm.
It’s a short window of time for each member of the care team to do their part, one that has required most areas of the care team to make changes to their workflows.
Robin Kaufman, DNP, APRN, FNP-BC, is the Perioperative Nurse Director who oversees operations in the Weiner Center for Pre-Operative Evaluation, Pre-Op Holding and the PACU. Her team is responsible for prepping patients for surgery and caring for them when they are first recovering from anesthesia. “Our staff has done a great job,” she says. “We also have Perioperative Clinical Champions, Charlene Salvi, BSN, RN, from the PACU, Sania O’Leary, BSN, RN, from Pre-Op Holding and Karen Lamping, NP, from the Weiner Center for Pre-Operative Evaluation, who have done incredible work to develop the clinical process for each area and collaborated with our 7th floor and interdisciplinary colleagues around the transition to the floor. They are also working to optimize patient education in our areas to ensure patients are receiving unified messaging that supports their progress through the day of surgery and beyond.”
Katie Killinger, MSN, BSN, NP-C, is the Chief Nurse Practitioner for Orthopeadic and Spine Surgery. She oversees the team of Advanced Practice Professionals (APPs) who also play a role. “In order to ensure that the patient has met the criteria for discharge, the Orthopeadic APP team worked closely with the surgeon and the outpatient provider to verify that the message was consistent throughout the team. We adjusted the discharge medications and prescription process, we altered our post-operative evaluation process, we implemented a protocol for hydration to avoid hypotension and we increased our facetime with these patient to ensure they and their families were prepared for discharge and properly educated on what to expect once home,” she says.
Mary Anne Barry, MBA, BSN, RN, is Nurse Director on 7 South, the inpatient unit that serves these patients during their brief admission to the hospital. “7 South staff have worked closely with Rehabilitation Services, the Orthopeadic APP team as well as the PACU staff to ensure a seamless process for the same-day patient,” she says. “The PACU and 7 South have created a checklist, which helps ensure that all elements required for discharge have been met.”
Jean Flanagan Jay, PT, DPT, CLT, is Director of Rehabilitation Services. On the day of surgery, her team is responsible for testing patients before discharge to make sure they can safely walk up and down stairs, enter and exit a car and use the bathroom. Patients are also instructed in exercises to begin their post-operative course for their hip or knee. “We have to get our part done, while still allowing the nurses time to do their education and care for the patient. We also have other surgery patients who need our services, so we work hard to prioritize our same-day patients with the whole house,” she says. “It’s really exciting to see what we’ve accomplished. And what I love is that we have such a great team. We’re all working and learning together.”
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