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.