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