Weston Outpatient Surgical Center Brings Total Joint Replacements to the Center

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Each year, more physicians and patients are choosing the ambulatory surgery center setting for total joint replacements. At-home recovery, lower costs and reduced risk of hospital-acquired infections are some of the drivers for this change in setting. In line with the trend, more of our centers are bringing total joint procedures to the facilities. Weston Outpatient Surgical Center in Weston, Florida, is one of the latest to begin performing total joint procedures.

“We made total joints a priority at the center, and with preparation, we were able to perform four procedures in the fourth quarter of 2019,” explained Estella “Stella” Castoreno, Center Leader at Weston. “I am a recent hire at Weston and bring several years of experience in total joints. I made a stretch goal for myself to bring joints to Weston Outpatient Surgical Center as my first quarter initiative.”

Pairing Stella’s own experience with a highly motivated staff, Weston established a special total joints committee to begin the preparations for the new procedures. “We had many comprehensive meetings with the staff, equipment representatives and surgeon. We also created a dictionary with a list of questions and responses so that every person involved in the procedures would be aligned with the overall goals and objectives in joint procedures. The staff, physicians and vendors aligned with one vision.”

Another factor in preparing to bring total joints to the center is ensuring the patients are right for the setting. A pre-telephonic assessment of the patient history and living accommodations were a top concern for the committee. The patients must meet the criteria for an outpatient joint. While there is a significant focus on patient selection, having a high-caliber orthopedic surgeon is even more important. Stella, said, “A successful joint program requires the right patient and right surgeon.”

Preparing for total joints at the center also required the commitment of every member of the 80+ person team. In addition to the special committee that focused on the new procedures, the staff not directly involved in total joints significantly helped by maintaining operations for the center’s regular volume, 600 cases annually.

As a new leader at the center, the preparation for the total joint procedures was also Stella’s time to get better acquainted with her staff and surgeons. “I approached it as taking it back-to-basics. We went through mock procedures with every bit of equipment and supplies needed for the case.  I even included the vendor representative in our mock case,” Stella said. “One of our techs played the role of patient. We had a lot of fun preparing for the procedures.”

“I encouraged the staff to see themselves as travel agents. Our patients expect to get through the joint replacement journey and back home refreshed with even more pep in their step,” explained Stella.

Weston’s first total joint patient had an opportunity to tour the center and meet every person who would interact with the case, from the billing office, registration clerk, nursing staff (pre-admission testing, pre-op, PACU and O.R.), scrub technicians, anesthesia team, physical therapist and administrator. This helped ensure the patient was comfortable when returning on the day of surgery.

Stella encourages centers considering adding total joints to make it relatable to the staff and to consider the three pillars — patient, staff and physician.

  • Patient – Personalize the goal with the patient. A great question is “What did you like to do prior to your knee weakness (walk the mall, plant flowers, etc.)?” Keep in mind, patient(s) don’t measure their quality of life by “ambulating 20 feet.”
  • Staff – To be successful, you must have complete buy-in from everyone at the center. Procedures can become transactional, so we must always take on the opportunity with the goal of creating exceptional experiences for the patients.
  • Physician – A highly skilled, reputable surgeon is just as important. Encourage surgeons to transition to outpatient by using the patient criteria screen tool in an acute care setting.

With four successful total joint replacements completed, Weston plans to continue to expand its total joint procedures. “We thank Dr. Mario Berkowitz, Dr. Alexander Bertot and Dr. Thomas Riley for trusting us to care for your patients. It is a great honor,” Stella concluded.

To learn more about the Weston Outpatient Surgical Center, visit https://westonoutpatient.com.

OrthoArizona Now Offering Outpatient Anterior Hip Replacements in Phoenix

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Dr. Michael Wilmink of OrthoArizona is leading the minimally invasive approach of how hip replacements are done.

Hip replacements are notorious for being complex with an overnight stay at the hospital.  The surgeons at OrthoArizona have now taken the next logical step with refinement of this procedure to allow patients to have their hip replaced at Gateway Surgery Center and go home the same day.  Patients are able to leave the surgery center approximately 3-4 hours after their surgery, walking with a walker and ready to start their rehabilitation.

Click here to read the full article.

Blue Water Surgery Center Performs Its First Total Joint Procedure

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From lower costs and attentive care to a reduced risk of hospital-acquired infections and at-home recovery, there are many benefits for patients who have total joint replacements in the ambulatory surgery center setting. The team at Blue Water Surgery Center in Port Huron, Michigan, recently completed its first total joint procedure, preparing the center to offer these benefits to patients in the market.

“We discussed performing total joint procedures at the center for years. We worried that the population in our market would not want to have such procedures at an ASC,” explained Karen Squires, Center Leader at Blue Water Surgery Center. “One of our doctors began exploring his cases and encouraging the team to investigate what would be needed to make the surgeries happen in our center.”

After exploration, the center staff took a year and a half to fully prepare to bring total joints to the center. During the preparation time, the center staff completed the large amount of due diligence needed to successfully complete their first knee replacement surgery.

Blue Water’s commitment to ensure the first total joint procedure was a success was evident in the amount of preparation the center completed. The team conducted a full run-through of the procedure to rehearse, prepare and ensure everything went as planned. The entire staff, clinicians and support roles, were engaged and invested in the process. “Each member of the team brought positive energy to this initiative. It was truly a team effort,” added Karen.

The Total Joints Toolkit is a helpful resource the center used in the preparation process as well. “We did not reinvent the wheel but used all of the resources around us to ensure we had a safe and successful outcome for our patient. There were templates and best practices from other centers in the network at our disposal.”

“We worked with the vendors, our AMSURG Materials Manager Bryan Wolf, our Operations Lead Linda White and the Total Joints Coordinator Troy Sparks to ensure we were fully prepared and resourced,” Karen said. “Our vendors and ASMURG were helpful and supportive from start to finish.”

One of the key elements of adding total joint procedures at the ASC is identifying the right patients.  Generally, younger, healthy patients with the right ensure make for the best candidates. Active lifestyles are also an important factor in having the procedure completed in the ASC. “Our first procedure, a knee replacement, took a total of three hours with great pain management. Our patient was also able to manage pain well at home.”

With one successful procedure complete, Blue Water plans to explore bringing more total joints procedures into the center. “We definitely want to get a few more procedures under our belt before we begin marketing the procedures at the center,” explained Karen, “Our goal is to expand our work in spine and total joints. We have also implemented a study for multimodal pain management.”

“I have been the Center Leader since 2006 and have always said total joints would never happen … in 2019, my biggest lesson and reminder is to never say never,” Karen concluded.

Orthopaedic Surgery Center of Ocala Performs 100th Total Joint Replacement Procedure

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On Jan. 10, the Orthopaedic Surgery Center of Ocala completed a left total hip replacement. It was the center’s 100th total joint replacement (TJR) since it started providing them in 2017.

Joseph Locker, M.D., one of the center’s two physicians who perform TJRs, led the milestone procedure. The patient did not require pain medication and was able to leave the surgery center on crutches that day after spending two hours in recovery. In his post-operation follow-up, the patient rated the overall experience and the facility as a 10 out of 10.

Shorter Total Joint Replacement Recovery Time Compared to Hospitals

100.2The physicians and staff at Orthopaedic Surgery Center of Ocala are committed to providing safe, high-quality, evidence-based care. As part of the center’s patient-centered approach, the team does not administer a spinal nerve block prior to surgery. Instead, they apply local anesthesia to the joint, which results in shorter recovery time and can have patients out the door within two hours after surgery.

Patients’ discharge is contingent upon ambulating to a reclining chair after the anesthesia wears off and demonstrating they can walk to their car. Following the surgery, patients are provided at-home physical therapy until the first post-operative appointment one week later. They are then transitioned to outpatient physical therapy.

These unique offerings have established Dr. Locker and his colleague, Zakariah Mahmood, M.D., as pre-eminent total joint orthopedic surgeons in the region. The center also relies on the expertise of surgeon Mark Rogers, M.D.

Surgery Center Patient Experience Surpasses Competitors

The staff at the center prides itself on going above and beyond the typical standard of care. The stellar patient experience is one of the many reasons the Orthopaedic Surgery Center of Ocala had a 97 percent patient satisfaction rate from April 2017-April 2018, as determined by Press Ganey’s annual patient survey. Little touches such as post-operative food and beverages and a tumbler emblazoned with Orthopaedic Surgery Center of Ocala Total Joint Program set the facility apart.

The Orthopaedic Surgery Center of Ocala opened its doors July 29, 2016. The 10,000-foot facility is certified by Medicare and the Accreditation Association for Ambulatory Health Care and has three operating rooms. It also offers completely private post-operative rooms to ensure patient comfort. While the most common TJR is a hip procedure, the team frequently performs total knee and total shoulder replacements. As more patients seek care in the outpatient setting, the team expects its TJR program to continue growing.

Short Hills Surgery Center Rallies Together During Winter Storms

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Winter storms have impacted the Northeastern region of the country, including the patients and staff at the Short Hills Surgery Center (SHSC) in Millburn, New Jersey. In the midst of a storm this winter, the SHSC staff went above and beyond for its patients and each other.

Due to road conditions, some patients were not picked up until after 10 p.m. The staff sprang into action to make the best of a bad situation, playing board games (courtesy of the PACU manager) and entertaining the patients while they waited.

A half dozen of the staff stayed overnight at the facility due to the treacherous road conditions. As the contracted housekeeping staff could not make it to the center, the team worked together to clean the clinical areas as well as take out the trash and dirty linen. After an uncomfortable night’s sleep, the staff was up early to prepare for the first patients of the day.

To assist the overnighters, a member of the staff brought in hot breakfast sandwiches with bagels, donuts, orange juice and, most importantly, toothbrushes and toothpaste. The center was open and ready for business the next day with all of the staff members in place. Although this was a difficult situation for all, there was good interdepartmental comradery and teamwork to help each other and the center through the storm.

“I couldn’t be more proud of this group of caring and devoted individuals,” said Claudette Fox, SHSC Center Leader.

Patient Praises Total Hip Replacement Experience at Florida Surgery Center

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Total hip replacements have dramatically increased in frequency in recent years, with more than 300,000 procedures performed annually. General wear and tear, rheumatoid arthritis and injury are just a few of the reasons why people decide to pursue hip replacement surgery. Like many people who experience severe, prolonged hip pain, John Adicks, a pharmacist from Gainesville, Fla., decided to explore his options for hip replacement.

Adicks wanted to have the procedure performed as soon as possible, so he scheduled it for November 2017 at Orthopaedic Surgery Center of Ocala, Fla., as opposed to a hospital outpatient department. The ease of scheduling the replacement was one of the selling points of having the procedure at a center; the hospital would have not been able to fit him into the schedule until March 2018. Adicks also stated, “I felt I would be exposed to far fewer germs in a surgery center setting than in a hospital.”

Upon arrival at the surgery center, Adicks and his wife Jeanette were pleasantly surprised by their experience. “Jeanette is a critical care nurse and she was very impressed by the facility,” Adicks said. Both noted how exceptionally clean the facility was and how quickly the process moved. After the procedure, Adicks left the facility on crutches and a physical therapist stopped by for a home visit shortly thereafter. Just two weeks later, he no longer needed the crutches.

For those contemplating a total hip replacement, Adicks said he could not stress enough how much the procedure reduced his pain: “I was in significantly more pain prior to the replacement and only experienced minor soreness after the procedure.” He previously had a knee replaced as a hospital outpatient and said the hip replacement surgery was a far superior experience, with regard to both pain and the care he received. Adicks recalled, “The staff took really great care of me. I would unequivocally recommend having a procedure at a surgery center after my experience exceeded expectations.”

AMSURG and a Partnering ASC Shared Total Joint Replacement Advice in OR Manager

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In OR Manager’s February 2018 issue, Troy Sparks, BSN, RN, CNOR, Regional Vice President and Total Joint Program Coordinator, AMSURG, shared advice on developing a high-quality total joint replacement program in ambulatory surgery centers (ASC). In the article titled, “Total joints present increasingly attractive option for ASCs,” he stressed the importance of physician leaders, strict patient eligibility criteria and patient education.

Sparks worked closely with Surgery Center of Long Beach, an AMSURG partner, to develop the program. In 2017, the center became the first ASC in the U.S. to receive a Center of Excellence Award in Orthopaedic Certification by the Accreditation Association for Ambulatory Health Care.

View the full article here.

How outpatient orthopaedics can benefit from ASC management partnerships

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With the advancements in total joint replacement surgery, more procedures are moving to an outpatient setting and starting the conversation of why to consider a surgery center management partnership.

“I think it’ll be commonplace 10 years from now where, if you have reasonably good health and you have a total knee or total hip, it will be done in a completely outpatient setting,” said AMSURG physician partner Lee Hunter, M.D., orthopaedic surgeon at the Surgery Center of Middle Tennessee. “[The] spine is not really my level of expertise, but I think many cervical disc fusions and standard lumbar cases, including some fusions, may be done as an outpatient surgery.”

Hunter offers valuable advice for practitioners who are interested in offering outpatient procedures in their facilities.

“As new procedures are done in an outpatient setting, there is a little bit of a learning curve, and there are certainly things that are easier to accomplish and things that are harder to accomplish. So I would say do something that you know is going to work,” Hunter said.

“Make sure you’re well prepared, those around you are well prepared, and basically plan for the worst. Make sure that your follow-up care, if there’s a rehab stay involved, is seamless and lined up before it comes to the launch day.”

Even with the best preparations in place, Hunter warns that there are will still be obstacles, and this is where it helps to have a surgery center management company partner to aid in that transition.

“If the partner takes over operational day-to-day management, either in conjunction with the physician team or completely takes it over, I think that lets the physicians practice medicine and worry less about the day-to-day issues, the hiring and the firing and the other things that go with the HR department," Hunter said.

A corporate surgery center partner can make the transition of a procedure to the outpatient setting easier by providing best practices, necessary documentation and connections to physicians who have already made a similar transition. It can also provide centers and physicians with research and information to help them stay competitive with other centers.

“AMSURG has been very, very good at tracking data within their centers and comparing that to data, available data nationally,” Hunter said. “We’re benchmarked, our center, to every other AMSURG center. We can compare that data. We compare our data on costing, what it costs for a suture anchor from this company here versus a suture anchor from the same company out in California, and all that is very, very useful as we negotiate contracts and really see where we stand. So I think AMSURG has been very useful [in providing] that data we otherwise wouldn’t be able to get.”

Click here to watch the complete interview with Dr. Hunter. Be sure to subscribe to our YouTube channel and be notified when AMSURG physician partners discuss surgery center insights and their experiences with an AMSURG partnership.