AORN Blog - The Periop Life

The Keys to Success in Total Joints

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August 26, 2021

Total joints are rapidly migrating to the outpa­tient arena and represent a growth opportu­nity for ASCs, but adding cases doesn’t auto­matically equate to excellent outcomes and prof­itability. You need to work with high-volume sur­geons, and have built-in efficiencies and protocols in place to deliver safe and cost-effective patient care.

Adolph V. Lombardi Jr., MD, FACS, will tell you how to achieve those goals during an exclusive workshop on the third day of Virtual OR Excellence. Dr. Lombardi is the president of JIS Orthopedics, the practice that runs White Fence Surgical Suites ASC in New Albany, Ohio. The cen­ter’s surgeons perform an average of 12 joint replacements each day, and completed the 12,000th replacement performed at the facility in June.

Dr. Lombardi will tap into his extensive expert­ise and innovative ideas in minimally invasive sur­gical techniques during what’s sure to be an informative and engaging discussion. “A typical ASC might not be structured to handle total joints,” says Dr. Lombardi. “I’ll be going over the basic requirements needed to launch an effective program, and how to advance existing programs.”

Here’s a slice of what Dr. Lombardi will discuss during the workshop.

  • Passion drives the train. Patients should fully understand what to expect on the day of surgery, and enter the episode of care with the mindset of preparing for same-day discharge and full recov­ery. Dr. Lombardi also believes providers must be passionate about total joints to succeed. “You have to have a zeal for the job at hand, and that positivi­ty absolutely must be contagious to your patients,” he says.

  • Improved instrument care. Surgeons must be accustomed to open­ing only the instru­ments that are essen­tial to the procedure, a practice that results in fewer items needing to be cleaned and steril­ized between cases. “Using fewer instru­ment sets cuts down on reprocessing times,” points out Dr. Lombardi.

    An effective instrument manage­ment plan is also essential to perfect­ing surgical work­flows. Surgical team members should know which tools to prioritize for repro­cessing and techs should standardize how they set up back tables. “You must pre-treat instruments the moment you’re finished with them in the OR to shave minutes from the time it takes to get them ready for the next case,” says Dr. Lombardi.

  • Enhanced recovery protocols. Dr. Lombardi created a Rapid Road to Recovery booklet for patients that includes the basics of hip and knee replacement care, answers to frequently asked questions, what to expect during the first two weeks of recovery and a list of potential complica­tions that require an immediate phone call to a member of the care team.

    His patients meet with a physical therapist seven days before their procedures to review the plan for early post-op ambulation and successful recoveries. “Providers must prepare patients for immediate rehabbing and know what to say during the first post-op phone call to make sure patients are doing well,” says Dr. Lombardi.

  • Versatile staff. Creating a team full of cross-trained providers is key. Circulating nurses should be able to scrub should the need arise, and scrub techs should be able to help out in sterile processing, according to Dr. Lombardi. “And for consistency of care, it’s best if patients are treated by the same nurses in pre- and post-op areas,” he says.

Dr. Lombardi will provide step-by-step instructions for pre­venting PONV and managing post-op pain, and share his patient selection parameters. Unlike many prac­tices, he doesn’t eliminate patients with high BMIs from consideration.

He’ll also discuss how to handle Medicare cases and offer his best tips for negotiating bun­dled payments with commercial insurers. He believes successfully aligning the financial inter­ests of surgeons, facilities and insurance compa­nies is more important than ever.

“I see a future in which only the most complex revision joint replacements will be done on an inpatient basis,” says Dr. Lombardi. “By focusing on the medical optimization of patients, constant­ly fine-tuning your clinical protocols and remain­ing focused on the best practices of same-day sur­gery, you can take your total joints program to the next level.”

This article originally appeared in Outpatient Surgery Magazine.

OR Excellence early-bird pricing through September 20!

Join Dr. Lombardi and Diane Doucette, MBA, RN at their OR Excellence conference workshop on October 14.

10:35 am – 12:20 pm ET
Set Up to Succeed in Total Joints
Register Today

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