Live Workshop: The Keys to Success in Total Joints

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.” OSM